Claims Administrator at De Beers Group

Job Description:

As a Claims Administrator, your responsibilities will include:

• Timeous and accurate capturing of claims
• Scanning and filing of paper claims
• Informing customers / providers regarding unclear / incomplete invoices via appropriate methods (e-mail and in writing / telephonically)
• Answering phones and resolving claim queries within determined SLA.
• Transferring customer calls to appropriate staff, where necessary.
• Identifying, researching, and resolving customer / provider issues using the computer system.
• Following up on customer / provider enquires not immediately resolved, within determined SLA’s.
• Completing call logs and reports.
• Following and adhering to claim processes, procedures and protocol
• Recognising, documenting, and alerting the supervisor of trends with processing of claims.
• Recommending process improvements.
• Focusing on first call resolution as far as possible.
• Other duties as assigned from time to time.
• This role is in the Project and SHE Department at a C1 level reporting to the Chief Professional Nurse.

Qualifications:

• Grade 12
• Please attach copies of all qualifications. Applications with no copies attached, will not be reviewed

Experience, Knowledge & Skills:

• At least 2 years’ working experience within a hospital, medical aid or insurance environment
• Claims processing experience (advantageous)
• Computer literate
• QMed experience would be advantageous
• Must have excellent people skills, writing and administration skills
• Communication skills and critical thinking
• Willing & able to work overtime / be on standby as per operational requirements
• Must have a driver’s license