Claims Administrator

1 day ago

Bryanston, South Africa Watershed Consulting Full time

Responsibilities
- Validate and process claims according to policy conditions, benefit, and business rules, manually or electronically, for all practice types, i.e. general or dental practitioners, pathology, radiology, and hospital claims.
- Assist the Claims Supervisor with claims administration business rules, standard operational processes claims improvement, as well as data quality management within the claims department.
- Assist with In-house training for new staff.
- Complete daily workflow processes within SLA.
- Effectively and professionally manage correspondence or claim queries received within SLA.
- Incorporating the principles of Treating Customers Fairly (TCF) in the claims process.
- Immediately refer suspicious or fraudulent claims to the Claims Supervisor or risk management department.
Mandatory requirements
- Matric
- FAIS Compliant (RE5 and Qualification are pre-requisites)
- Customer Service Certificate

**Salary**: Up to R18,000.00 per month

**Experience**:

- Claims Administration: 3 years (required)
License/Certification:

- FAIS Compliant License/Certificate? (RE5 a Pre-requisite) (required)
- Customer Service Certificate? (required)

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