Claims Administrator - East Johannesburg
National Risk Managers Ltd
Join Our Exclusive Talent Pool We believe in nurturing talent and providing a platform for growth. As we expand our horizons, we are building a talent pool of passionate Claims Administrators who share our commitment to excellence. Job Summary Administer payments of Health claims Key Responsible Areas Process hospital admission and related accounts received Perform administrative duties Tasks Process hospital admission and related accounts received Receive accounts and authorisation letters Opening accounts received Compare ICD10 codes to determine if it’s a condition we cover or an exclusion Process day to day claims Perform administrative duties Capture notes into the relevant folders and claims management system Advise the Providers/ Members when maximum benefits have been paid Request decline letters for conditions/ accounts not covered Engage with Members/ Providers regarding their queries Contact Members when they are unsure about their cover, benefit limits, declines or payment allocations and provide them with detailed statements or reports Provide Members, Agents or Service Providers with feedback with regards to the claim progress Check hospital claims for correctness (completed in full) Send proof of payments to Members/ Service providers File POP’s and accounts Send out daily statistics Obtain all the relevant documentation required for the applicable benefit Perform administrative duties File all relevant emails Capture claims on the claims management system Reconcile account received and send to the financial administrator for payments to be loaded Compile and submit periodic reports Essential Qualifications Matric Essential Experience Minimum 2 years in the insurance industry and its products. Knowledge and Skills Excellent administrative skills Knowledge of medical claims handling Knowledge of and adherence to the Policies and Procedures relating to hospital claims Knowledge of medical operating systems Excellent computer skills (MS Office, Excel) Excellent written and communication skills Time management skills Excellent interpersonal skills Client relationship-building skills Attributes Patience (to deal with difficult Members) Positive attitude Ability to multi-task Professional demeanor and appearance Team player/ work independently High level of enthusiasm Innovative/ energetic Ability to work under pressure High degree of commitment Motivated Accuracy Deadline orientated Honest, hardworking and humble
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