To support the management team in the client’s Management department and to attend to escalated queries. To ensure the prompt resolution of member queries regarding all medical aid claims, telephonically and in writing.

Key Activities

• Defined legal, statutory and regulatory compliance is maintained at the required standards
• Operational risk and governance structures, measures and frameworks are complied with and necessary action is taken to address issues, when necessary
• Ensure that payments were processed at correct rate and against available benefits
• Investigate all documentation, correct where required and link to member's records
• Analyse and correct incorrect payments and identify reason for non-payment. Apply
• Quality Analysis checklist to processing of claims
• Provide comprehensive and accurate feedback to clients
• Identify system constraints and escalate accordingly
• Assist in Call Centre/other areas when required
• Ensure that quality control targets are met
• Meet delivery objectives through working with other team members within and linked to the department / project
• Resolve operational performance variations and problems and escalate unresolved issues to higher levels
• Ensure delivery targets/objectives are met and operate in a supportive manner to achieve successful delivery
• Ensure appropriate, active and informative relationships with customers and relevant stakeholders are successfully achieved
• Address customer or stakeholder complaints in alignment with the policies and procedures and ensuring customer / stakeholder buy-in

Skills

• Problem solving and decision making skills
• Business Writing Skills
• Communication Skills
• Computer Technology Skills
• Task Management
• Adobe Creative Suite
• Data modelling and evaluation
• Attention to Accuracy and Detail
• Numerical Ability
• Customer Focus
• Relevant systems knowledge and application

Experience and Qualifications

1 - 2 years’ experience in the medical aid industry, Business writing skills in English is essential, Investigative, communication and interpersonal skills required, In depth working knowledge of the client’s rules will be advantageous, Claims processing experience essential

Company Description – A formidable company that aims to deliver exceptional services.