PURPOSE OF THE ROLE
Supervise and provide on the job training to the admin staff in order that they can handle their daily transactions within the context of:
Expeditious completion of medical report requests
Claim status update to medical providers
Third party recoveries administration and Provider Admin Fees Recons/Payments
Prompt clearance of pending cases
Process claims transactions within the required benchmarks and authority limit, communicate claims decisions in a clear and simple manner, provide claims handling service to clients and intermediaries as and when required
Produce monthly management reports for Senior Management
Perform monthly financial reconciliation of unresolved transaction history in RCS.
FRCF representative for the yearly attestation process including testing.
Write and update operational manual on claim administration.
Review medical reports submitted at New Business stage for moratorium cases and update impact on claim decision on to RCS.
Perform required actions on RCS exception reports.
Monitor and clear pending claims and discuss with manager to cancel the complex long standing cases.
Work with the department project leader to tailor solutions for each project and attend meetings when required.
Provide feedback loop relating to difficulties in claim administration issues, identify process improvement and system enhancement for Individual Health claims.
Involve in user acceptance testing for new system changes to ensure claims scenarios are duly covered.
Influence and put into practice System Thinking in staff training and day-to-day operations to ensure that service standards are maintained or exceeded so as to contribute positively to Net Promoter Score.
Reviewing training materials with claims manager before release for adviser training.
Provide support in FAQ sessions during adviser training.
Ensure that risks taken in own areas of work are controlled within approved limits.
Handling complaints effectively and timely.
Ensure all claims documentation and procedures adhere to company and claims management requirements
Ensure key risks have been understood, identified and managed and/that, where concerns or doubts exist, are raised with line management.
Insurance professional qualifications preferred
Able to communicate effectively with all levels.
Good technical knowledge of Life & Health Insurance.
Good team worker and service-oriented.
Results-focused personality is essential.
Proficiency in computer applications – Microsoft office.
At least 4 years working experience in health claims department.
Health insurance knowledge is required.
Supervisory skills or experience is preferred orhas to be learnt on the job