Claims Officer - Medical Department at Absa Bank Limited

Job Summary

To support the Head of Medical Claims in the Medical Department by providing operational support in the Medical Department processes. To process and settle insurance claims in a fast, fair and courteous manner to ensure customer satisfaction, company profitability and good corporate image

Job Description

Claims vetting and approval (90%)

• Receiving and registering incoming claims.
• Claims adjudication.
• Analysing all patients claims (In terms of completeness and validity) and processing them for payment.
• Examining and confirming member benefits, entitlements and exclusions.
• Preparing member statements (on request) for clients regarding their policy benefit utilisation status.
• Preparing payment remittances and credit notes where applicable.
• Liaising with providers on claims queries .
• Prepare management reports.

Customer service, provider negotiations and reconciliation (10%)

• Handling customer queries (walk-in, phone & e-mail) in regards to claims and payments
• Assist in reconciliation and attending reconciliation meetings with the providers