To support the Head of Medical Claims in the Medical Department by providing operational support in the Medical Department processes. To process and settle insurance claims in a fast, fair and courteous manner to ensure customer satisfaction, company profitability and good corporate imageKey Responsibilities.
Claims vetting and approval (90%)
Receiving and registering incoming claims
Claims adjudication
Analysing all patients’ claims (In terms of completeness and validity) 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 where there queries on the claims submitted
Customer service, provider negotiations and reconciliation (10%)
Handling customer queries (walk-in, phone & e-mail) in regards to claims and payments
Assist in reconciliation and attending reconciliation meetings with the providers
Review of provider’s charges and negotiating for better rates
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