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

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.

Reporting and Data Management:

• Maintain accurate records of claims transactions, prepare claims registers, and contribute to periodic reporting and performance tracking.

Delegated Authority:

• Act within the scope defined by the approved Delegated Authority Matrix.

Knowledge, Experience, and Qualifications Required:

• Bachelor's degree in Business Administration or related field.
• Excellent attention to detail.
• Good interpersonal and communication skills.
• Ability to work under pressure and meet tight deadlines.
• Proficiency in Microsoft Office and medical claims systems