Claims Administrator (Medical Gap Cover)- 3 Months Temp
Watershed Consulting · Bryanston, Gauteng
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Start free — we apply for you →Job Title: Claims Administrator (Medical Gap Cover)- 3 Months Temp
Our client in healthcare insurance is seeking a claims administrator with experience in claims processing, gap cover and conversant with ICD 10 codes.
This role is responsible for the accurate and efficient assessment of medical claims, ensuring that all processing aligns with policy rules, benefits, and conditions.
Duties & Responsibilities
Key Responsibilities
- Claims Processing: Accurately assess claims, ensuring zero errors, and process them according to specific policy rules, benefits, limitations, waiting periods, and exclusions.
- Information Gathering: Proactively request outstanding documents or information from clients via telephone and email.
- Customer Service & Escalations: Handle customer queries and escalations professionally, providing high levels of client satisfaction.
- SLA Compliance: Ensure all work and claims processing is completed strictly within the agreed Service Level Agreement (SLA).
Desired Experience & Qualification
Qualifications Required
- Matric
- RE5
- FAIS Compliant
- Customer Service Certificate
Skills & Experience
- A minimum of 2 years of experience in medical gap cover or medical aid claims.
- Sound computer skills with intermediate to advanced proficiency in Microsoft Office.
- Excellent English written and verbal communication skills.
Personal Attributes
- Resilient & Professional: Ability to handle highly pressurised volumes while always remaining calm, friendly, courteous, and polite.
- Accountable: Takes full ownership, accountability, and responsibility for tasks.
- Detail-Oriented: Pays meticulous attention to detail to ensure accurate claims processing.
- Collaborative: An excellent team player who is always willing to assist.