Senior Claims Officer - Medical Department (FAK) at Absa Bank Limited

Job Summary

• To deliver claims related administrative support services through the execution of predefined objectives as per agreed standard operating procedures.

Job Description

Claims vetting and approval (90%)

• Receiving and registering incoming claims.
• Claims adjudication.
• Analysing all patients’ claims (In terms of completeness, validity, clinical) 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.
• Oversee daily operations in medical claim section.

Customer service, provider negotiations and reconciliation (10%)

• Handling customer queries (walk-in, phone & e-mail) regarding claims and payments.
• Assist in reconciliation and attending reconciliation meetings with the providers.
• Review of provider’s charges and negotiating for better rates and packages.

Academic & Professional Qualification

• Bachelor’s degree in pharmacy /Clinical Medicine /Nursing
• COP (certificate of proficiency in Insurance) & ACII will be an added advantage.

Relevant work experience.

• At least 4 - 5 years’ experience in a busy insurance related field.
• Strong analytical skills required.