Claims Assistant - Medical

1. Verify and capture outpatient and inpatient claims as per the claims manual
2. Assess medical claims documents for authenticity and process payments within set service levels
3. Register and process all reported medical claims and appoint relevant service providers where applicable and advice the clients on the required claims supporting documents
4. Raise payment requisitions within the set standards
5. Liaise with the finance department to ensure safe and timely dispatch of reimbursement claims cheques to clients
6. Ensure all claims documents are archived in the relevant systems Assist in case management activities
7. Promptly and efficiently attend to customer queries, and complaints
8. Deliver on performance requirements as defined in the departments’ strategy map, balanced scorecard and Personal Scorecard. 

• Gross Loss Ratio
• Customer turnaround time
• Accuracy in posting

• Required to liaise and work closely with the other departments as may be necessary

• Britam customers
• Insurance sector players
• Hospitals and other service providers

Knowledge, experience, and qualifications required

1. Diploma (Nursing and Medicine preferred)
2. 1-2 years’ experience in medical claims
3. Knowledge of Britam health product

1. Learning and Researching: Rapidly learns new tasks and commits information to memory quickly; demonstrates an immediate understanding of newly presented information; gathers comprehensive information to support decision making at management level; learns from successes and failures and seeks colleague and customer feedback.
2. Working with People: Shows respect for the views and contributions of other team members; shows empathy; listens, supports and cares for others; consults others and shares information and expertise with them; builds team spirit and reconciles conflict; adapts to the team and fits in well.
3. Applying Expertise and Technology: Applies specialist and technical expertise; uses technology to achieve work objectives; develops job knowledge and expertise (theoretical and practical) through continual professional development; demonstrates an understanding of different organisational departments and functions.
4. Delivering Results and Meeting Customer Expectations: Focuses on customer needs and satisfaction; exhibits high standards for quality and quantity; monitors and maintains own quality and productivity; works in a systematic, methodical and orderly way; consistently achieves projects goals.
5. Following Instructions and Procedures: Follows procedures and policies; keeps to schedules; arrives punctually for work and meetings; demonstrates commitment to the organisation; complies with legal obligations and safety requirements of the role.
6. Adhering to Principles and Values: Upholds ethics and values; demonstrates integrity; accepts diversity; display individual responsibility towards the community and the environment; models the organisational values during every day interactions.