Claims Administrator
7 months ago
Join Our Exclusive Talent Pool
We believe in nurturing talent and providing a platform for growth. As we expand our horizons, we are building a talent pool of passionate Claims Administrators who share our commitment to excellence.
**Job Summary**
Administer payments of Health claims
**Key Responsible Areas**
- Process hospital admission and related accounts received
- Perform administrative duties
**Tasks**
**Process hospital admission and related accounts received**
- Receive accounts and authorisation letters
- Opening accounts received
- Compare ICD10 codes to determine if it’s a condition we cover or an exclusion
- Process day to day claims
- Perform administrative duties
- Capture notes into the relevant folders and claims management system
- Advise the Providers/ Members when maximum benefits have been paid
- Request decline letters for conditions/ accounts not covered
- Engage with Members/ Providers regarding their queries
- Contact Members when they are unsure about their cover, benefit limits, declines or payment allocations and provide them with detailed statements or reports
- Provide Members, Agents or Service Providers with feedback with regards to the claim progress
- Check hospital claims for correctness (completed in full)
- Send proof of payments to Members/ Service providers
- File POP’s and accounts
- Send out daily statistics
- Obtain all the relevant documentation required for the applicable benefit
**Perform administrative duties**
- Capture claims on the claims management system
- Reconcile account received and send to the financial administrator for payments to be loaded
- Compile and submit periodic reports
**Essential Qualifications**
- Matric
**Essential Experience**
- Minimum 2 years in the insurance industry and its products.
**Knowledge and Skills**
- Excellent administrative skills
- Knowledge of medical claims handling
- Knowledge of and adherence to the Policies and Procedures relating to hospital claims
- Knowledge of medical operating systems
- Excellent computer skills (MS Office, Excel)
- Excellent written and communication skills
- Time management skills
- Excellent interpersonal skills
- Client relationship-building skills
**Attributes**
- Patience (to deal with difficult Members)
- Positive attitude
- Ability to multi-task
- Professional demeanor and appearance
- Team player/ work independently
- High level of enthusiasm
- Innovative/ energetic
- Ability to work under pressure
- High degree of commitment
- Motivated
- Accuracy
- Deadline orientated
- Honest, hardworking and humble
For more information please contact:
**Nirusha Sampat
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