Medical Claims Assistant

Job Purpose:

The role involves delivering excellent client service, as well as the accurate processing and payment of Britam Connect medical claims, conducting data analytics, reporting, ensuring high-quality service, customer experience and cost control.

Key Responsibilities:

Processing of claims and payments for service providers and clients.

Conduct data analytics and prepare reports of claims for both medical and non-medical claims.

Communicate with clients and healthcare providers to ensure that services rendered are within policy limits and guidelines.

Review medical reports and claims for compliance with established medical and insurance guidelines.

Liaise with underwriters to clarify the scope of cover for various schemes.

Promote the use of generic medications where clinically appropriate to reduce pharmaceutical costs using internal systems and analytics.

Review and validate documents and other relevant requirements related to claims submitted by providers and clients.

Ensure all submitted claims are complete, accurate, and compliant with the required documentation.

Manage and maintain strong relationships with clients, intermediaries, and healthcare service providers.

Verify and audit both outpatient and inpatient claims to ensure accuracy and mitigate financial and operational risks.

Provide basic advisory support to claimants regarding their insurance coverage in relation to their claims.

Respond to internal and external inquiries regarding claim procedures, service providers, and required documentation.

Industries:Health, Wellness & Fitness

Function: Data Science