Medical Claims Assistant (Short-Term Contract - 3 Months)

Job Purpose:

To support the effective and timely reconciliation, processing, and payment of BMI medical claims, ensuring quality and cost-effective care for clients. The role also includes contributing to the resolution of the current claims backlog within a defined period, while maintaining high standards of accuracy, customer service, and policy compliance.

Key Responsibilities:

Claims Backlog Clearance:

Support the reconciliation and sign-off of pending claims to meet the three-month backlog clearance target, ensuring accuracy and adherence to policy guidelines.

Claims Review and Processing:

Evaluate and process inpatient and outpatient claims in line with Britam’s policies, clinical standards, and documentation requirements.

Customer and Provider Engagement:

Liaise with service providers and clients to ensure medical care is delivered within covered limits, while managing expectations professionally and promptly.

Claims Compliance:

Review claims and medical reports to ensure compliance with scheme benefits and clinical appropriateness.

Claims Verification and Audit:

Conduct verification and audits of submitted claims to minimize fraud, errors, and misuse.

Documentation Management:

Track, follow up, and validate all necessary documentation to complete claims processing within the required turnaround time.

Industries:Health, Wellness & Fitness

Function: Healthcare Administration