Claims Manager - Pet Insurance at Oneplan Underwriting Managers (Pty) Ltd

Duties & Responsibilities:

Authorisation Management:

• Oversee the entire insurance authorisation process for veterinary hospital services, including surgeries, treatments, and diagnostic procedures.
• Overseeing and ensuring all necessary documentation, including medical records, is submitted accurately and in a timely manner.
• Ensuring productivity and execution of authorisations are done timeously.
• Resolve issues with denied claims, claim queries or delayed authorisations.

Administrative Operations:

• Supervise administrative staff responsible for managing patient / client registrations, assessment of claims, and other clerical functions.
• Implement efficient administrative workflows and ensure proper record-keeping.
• Collaborate with clinical departments to ensure smooth coordination between administrative and administrative functions from suppliers.

Financial Oversight:

• Collaborate with the finance department to track and monitor administration and authorisations for payment processing.
• Oversee cost estimates for claims and review concerns related to the product policies for approval of claims.

Team Leadership:

• Lead and develop a team of administrative and authorisation staff, providing training and mentoring as needed.
• Set performance goals for the team and ensure they meet the established standards.
• Conduct performance reviews and provide ongoing feedback for team improvement.

Compliance & Reporting:

• Ensure adherence to all legal, regulatory, and accreditation standards related to veterinary hospital administration claims and pet insurance practices.
• Prepare regular reports on authorisations, denials, and pending claims for senior management.
• Maintain records of all authorizations, including dates, approvals, denials, and appeals.
• Reporting may be required on multiple projects and ensuring delivery on expected timelines / targets set.

Key requirements of the role:

Education:

• Bachelor’s degree in business financial administration (BCom), Business Management Degree / Qualification (NQF5) and or Bachelor of science (BSc) or a related field, would be preferable and advantageous.
• Medical workplace experience working within a veterinary clinic / hospital or medical centre for 2-3 years.
• Qualified Veterinary Nurse would be advantageous and should be very familiar with the veterinary clinic services and practices.
• Additional certifications in pet healthcare management or insurance billing are a plus.

Experience:

• 5+ years of experience in pet healthcare administration, including at least 2 years in an insurance authorisation or billing role.
• Proven experience managing a team within a pet healthcare setting.
• In-depth knowledge of pet health insurance policies, reimbursement processes, and authorization procedures.
• Familiarity with veterinary service, pet hospital administrative processes and insurance claim systems.
• Proficient in office management software and Microsoft Office Suite.
• Strong organizational and leadership skills.
• Excellent communication and interpersonal abilities.
• Ability to multitask and prioritize effectively in a fast-paced environment.
• Problem-solving skills and attention to detail.
• Highly administrative and accurate in execution of tasks.
• Proven experience as an Admin Manager or in a similar role, including motivating of staff and ensuring the team is highly productive.