Subscribe to email job alerts
Advertise your job vacancies
Prepaid job ad packages
| Job | Normal cost | Discount | Cost | Saving |
|---|---|---|---|---|
| 4 | R2,000 | 27% | R1,460 | R540 |
| 6 | R3,000 | 29% | R2,130 | R870 |
| 8 | R4,000 | 31% | R2,760 | R1,240 |
| 12 | R6,000 | 35% | R3,900 | R2,100 |
Claims Administrator
| Location: | South Africa |
| Education level: | Diploma |
| Job level: | Junior/Mid |
| Company: | Ambledown |
Qualifications:
- Clinical Diploma/Degree
- SANC Registered
- FAIS Compliant
- A minimum of 2 years’ gap cover claims experience
- Technical knowledge on various health insurance products
- Advanced knowledge of ICD Codes, medical procedures and medical aid schemes
- Sound understanding of the Prescribed Minimum Benefits (PMB) legislation in conjunction with gap cover
- Strong computer skills, including Microsoft Office and intermediate to advanced Excel skills
- Excellent customer service, communication, and interpersonal skills
- Advanced Business English (written and verbal)
- Strong attention to detail and accuracy
- Analytical and problem-solving skills with the ability to interpret clinical information
- Ability to take ownership and responsibility for actions and outcomes
- Ability to handle pressure while remaining calm, professional, courteous, and solution-oriented
- Experience in dealing with escalated and/or complex claims queries is an advantage
- Ability to work independently and as part of a team.
Scope of Responsibility:
- Assess claims in accordance with policy rules, benefits, and conditions
- Conduct clinical review and validation of pre-existing conditions and casualty claims
- Attend to escalated and complex clinical queries
- Respond to broker and policyholder queries in a timely and professional manner
- Ensure compliance with internal policies, procedures, and regulatory requirements
- Maintain accurate records and documentation of claims assessments and outcomes.
- Contribute to process improvement initiatives within the claims department.
- Any other duties as assigned by the company from time to time.
The company reserves the right to change this job description at its sole discretion from time to time.
Posted on 31 Mar 15:11, Closing date 6 Apr
Or apply with your Biz CV
Create your CV once, and thereafter you can apply to this ad and future job ads easily.
For over two decades, Ambledown has been a trusted partner in South Africa’s healthcare landscape, helping individuals and families navigate the financial challenges of medical expenses.
Disclaimer: This is not a medical scheme, and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.
Disclaimer: This is not a medical scheme, and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.
Next