Medical Claims Specialist

6 days ago


Cape Town, Western Cape, South Africa Momentum Full time
Job Description

The position of Clinical Administrator is responsible for handling claims clinical responsibilities for GAP Short Term Insurance Products, ensuring that the principles and outcomes of Treating Customers Fairly (TCF) are practiced and achieved.

  • This includes investigating PMB internal claims and negotiating discounts with service providers.
  • Conducting pre-existing claim investigations and recommending outcomes.
  • Resolving client queries and managing expectations.

Key Responsibilities:

  • Handle claims clinical responsibilities for GAP Short Term Insurance Products.
  • Ensure TCF principles and outcomes are practiced and achieved.
  • Investigate PMB internal claims and negotiate discounts with service providers.
  • Conduct pre-existing claim investigations and recommend outcomes.
  • Resolve client queries and manage expectations.
Requirements

To be successful in this role, you will need to have:

  • A Matric/Grade 12 National Senior Certificate or equivalent.
  • A relevant qualification in a medical or related field, such as nursing or medical technology.
  • Minimum 2-3 years of experience within the life insurance industry in a clinical or claims assessment/administration role.
  • Strong knowledge of medical aid schemes.
  • An understanding of anatomy and physiology.
  • Proficient in Microsoft Office and claims management systems.


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