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.
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