Job Purpose and Key responsibilities
- The role holder will be responsible for processing medical claims with a focus on controlling and management of member benefits through vetting of inpatient and outpatient bills. The role will report to the Assistant Manager-Medical Claims
- Verify and capture outpatient and inpatient claims as per the claims manual
- Assess medical claims documents for authenticity and process payments within set service levels
- Register and process all reported medical claims and appoint relevant service providers where applicable and advice the clients on the required claims supporting documents
- Raise payment requisitions within the set standards
- Liaise with the finance department to ensure safe and timely dispatch of reimbursement claims cheques to clients
- Ensure all claims documents are archived in the relevant systems Assist in case management activities
- Promptly and efficiently attend to customer queries, and complaints
- Deliver on performance requirements as defined in the departments’ strategy map, balanced scorecard and Personal Scorecard.
- Gross Loss Ratio
- Customer turnaround time
- Accuracy in posting
- Internal Relationships:
- Required to liaise and work closely with the other departments as may be necessary
External Relationships:
Britam customers
Insurance sector players
Hospitals and other service providers
Knowledge, experience and qualifications required
- Diploma (Nursing and Medicine preferred)
- 1-2 years’ experience in medical claims
- Knowledge of Britam health product
- Learning and Researching: Rapidly learns new tasks and commits information to memory quickly; demonstrates an immediate understanding of newly presented information; gathers comprehensive information to support decision making at management level; learns from successes and failures and seeks colleague and customer feedback.
- Working with People: Shows respect for the views and contributions of other team members; shows empathy; listens, supports and cares for others; consults others and shares information and expertise with them; builds team spirit and reconciles conflict; adapts to the team and fits in well.
- Applying Expertise and Technology: Applies specialist and technical expertise; uses technology to achieve work objectives; develops job knowledge and expertise (theoretical and practical) through continual professional development; demonstrates an understanding of different organisational departments and functions.
- Delivering Results and Meeting Customer Expectations: Focuses on customer needs and satisfaction; exhibits high standards for quality and quantity; monitors and maintains own quality and productivity; works in a systematic, methodical and orderly way; consistently achieves projects goals.
- Following Instructions and Procedures: Follows procedures and policies; keeps to schedules; arrives punctually for work and meetings; demonstrates commitment to the organisation; complies with legal obligations and safety requirements of the role.
- Adhering to Principles and Values: Upholds ethics and values; demonstrates integrity; accepts diversity; display individual responsibility towards the community and the environment; models the organisational values during every day interactions.
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