Medical Claim Administrator jobs

NBC Holdings is a leading force in the South African employee benefits arena, providing a comprehensive range of employee benefits, products and services.

We are seeking a Claims Administrator to accurately and timeously process claims. Assess claim documents and determine validity. Investigate claims and gather information from members, employers and others. Evaluate claims based on policy coverage and laws. Monitor defence activities and ensure claim-related issues are resolved.

Key Outputs:

• Process all claims, withdrawals, divorce, maintenance, death / transfers
• Managing the entire claims process, including investigating claims.
• Ensuring accuracy and compliance with plan guidelines.
• Communicating with members and employers regarding the status of their claims.
• Addressing any inquiries or issues that may arise.
• Verifying necessary documents.
• Accurately inputting claim details into the claims management system and updating claim status throughout the process.
• Calculating the appropriate benefit amount based on the plan rules and claims details.
• Explaining claim decisions and addressing concerns in a clear and professional manner.
• Strong understanding of employee benefit plans and related regulations.
• Attention to detail and ability to work accurately with complex data.
• Ability to work independently and meet deadlines.
• Identifying potential fraudulent claims and taking appropriate action to investigate and report them.

Experience:

• 2 - 3 years of experience in the employee benefits field.
• Experience with claims processing system, and strong administrative skills to accurately review and manage claims data.
• Knowledge of relevant laws and regulations governing employee benefits.
• Computer literate. System knowledge. Excel knowledge.

Qualifications:

• Matric
• BCom in Finance or equivalent qualification
• NQF Level 4. Courses in insurance (CISR or CEBS)

Skills & Behavioural attributes:

• Adhere to company procedures and standards
• Excellent communication skills
• Team player
• Problem solver
• Project a professional image at all times
• Excellent communication skills
• Ability to deal with people at all levels
• Ability to work accurately under pressure
• Ability to deliver on service level agreements and tight deadlines
• Ability to work independently
• A strong sense of responsibility

Package & Remuneration

• Market Related
• Medical Aid
• Provident Fund
• Group Life