Job Summary
To deliver claims related administrative support services through the execution of predefined objectives as per agreed standard operating procedures.
Job Description
Claims vetting and approval (90%)
Receiving and registering incoming claims.
Claims adjudication.
Analysing all patients’ claims (In terms of completeness, validity, clinical) and processing them for payment.
Examining and confirming member benefits, entitlements and exclusions.
Preparing member statements (on request) for clients regarding their policy benefit utilisation status.
Preparing payment remittances and credit notes where applicable.
Liaising with providers on claims queries.
Oversee daily operations in medical claim section.
Customer service, provider negotiations and reconciliation (10%)
Handling customer queries (walk-in, phone & e-mail) regarding claims and payments.
Assist in reconciliation and attending reconciliation meetings with the providers.
Review of provider’s charges and negotiating for better rates and packages.
Academic & Professional Qualification
Bachelor’s degree in pharmacy /Clinical Medicine /Nursing
COP (certificate of proficiency in Insurance) & ACII will be an added advantage.
Relevant work experience.
At least 4 – 5 years’ experience in a busy insurance related field.
Strong analytical skills required.
Apply via :
absa.wd3.myworkdayjobs.com
