Claims Administrator

7 days ago


Sandton, South Africa Watershed Consulting Full time

Our client in the Healthcare Insurance space is looking to employ a Claims Administrator

**Responsibility**:
- Assess claims.
- Ensure that claims are processed according to the rules, benefits, and conditions of the policy.
- Contact service providers for discounts when claims are over the company prescribed threshold.
- Ensure that all policy limitations, waiting periods, exclusions are appropriate and in line with the policy.
- Attend to customer queries.
- Any other duties as requested by the company from time to time.

**Qualifications**:
- Matric
- FAIS Compliant (**Qualification and RE 5**)
- Customer Service Certificate

**Skills and Experience**:
- At least 2 years’ gap cover or medical claims experience.
- Technical knowledge of various health insurance products.
- Knowledge of ICD Codes, medical procedures, and medical aid schemes.
- Understanding of PMB legislation in conjunction with Gap Cover.
- Sound computer skills - Microsoft Office a must.
- Excellent customer service skills.
- Takes ownership and responsibility.
- Ability to work in a team with mínimal supervision.
- Pays attention to detail.
- Excellent analytical skills.
- Ability to handle pressure - always remain calm, friendly, courteous, polite, professional, and willing to assist


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