Insurance Claims and Policy Processing Clerk

Job Description

As a Medical Insurance Specialist, you'll manage medical insurance claims and ensure accurate processing. You'll liaise with healthcare providers and insurance companies to resolve discrepancies.

Responsibilities

• Evaluate claims for compliance with healthcare policies.
• Perform follow-up calls to ensure all necessary information is obtained.
• Work closely with the finance department for claims payment.
• Gather data for periodic claims performance reviews.
• Participate in ongoing training for medical billing and coding.
• Help resolve patient complaints related to claims.
• Assist in claims reconciliation and audits.
• Develop strong relationships with insurance partners.
• Support the continuous improvement of claims processes.
• Document and maintain comprehensive records of all communications.

Requirements

Education

• Relevant qualification in Healthcare Administration

Experience

• Experience in client-facing roles or customer service

Technical Skills

• Proficiency in Microsoft Office Suite (Word, Excel, Outlook)
• Knowledge of Medical Terminology

Soft Skills

• Problem-Solving
• Team Collaboration

Certifications

• Certified Medical Insurance Specialist

Languages

• English: Fluent
• Xhosa: Conversational

Advantageous

• Bilingual proficiency: Ability to communicate in both English and Afrikaans or another language.
• Knowledge of South African healthcare regulations: Understanding the legal and regulatory framework governing healthcare in South Africa.

Benefits

• Comprehensive healthcare benefits
• Retirement savings plans
• Ongoing training and development opportunities
• Paid time off and public holidays

Company Culture

• Innovation-Driven: We value creativity and encourage our employees to come up with innovative solutions.
• Team Collaboration: Our team thrives on collaboration, ensuring all voices are heard and valued.
• Health and Well-being: We strongly support work-life balance and employee well-being initiatives.