Job Summary
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 image.
Job Description
Claims vetting and approval (90%)
Receiving and registering incoming claims.
Claims adjudication.
Analyzing 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 utilization status.
Preparing payment remittances and credit notes
where applicable.
Liaising with providers on claims queries.
Prepare management reports.
Customer service, provider negotiations and
reconciliation (10%)
Handling customer queries (walk-in, phone &
e-mail) regarding claims and payments
Assist in reconciliation and attending reconciliation
meetings with the providers.
Education
Further Education and Training Certificate (FETC):
Financial Sciences (Required)
How To Apply
