Overview
Claims Administrator – Health Jobs in Blantyre, Southern Region, Malawi, Malawi at Libertas General Insurance Co. Ltd
Title: Claims Administrator – Health
Company: Libertas General Insurance Co. Ltd
Location: Blantyre, Southern Region, Malawi, Malawi
JOB TITLE :Claims Administrator
DEPARTMENT :Health
REPORTING TO : Health Operations Manager
Job Purpose
To ensure that all electronic and physical claims and correspondence received in the business are routed timeously to all levels within the organisation, for both internal and external stakeholders.
Key Responsibilities
- To ensure all claims are prepared in accordance with departmental standards, in order to ensure that claims are processed accordingly
- To ensure that all claims have valid member / provider details and are placed in batches
- To scan all claim and correspondence batches and route to the relevant department.
- To ensure that all enquiries from both internal and external customers are investigated and resolved within the SLA and to provide either written or verbal feedback to the relevant stakeholder.
- To compile reports, utilising Excel, based on claims received.
- To verify member and provider details and source outstanding information, in order to enable accurate and swift processing of claims.
- To liaise with providers confirming cover and benefits, where necessary
CUSTOMERS / STAKEHOLDERS
Internal
- Operations team
- Finance Team
- Member Care
External
- Members
- 3rd Party Service Providers
DECISIONS
Decisions as outlined by the scope of role and responsibilities in line with the rules and regulations of the medical scheme.
TIME HORIZON
Short Term
KNOWLEDGE
Knowledge Level (Basic, Intermediate, Advanced) Understanding of tariff guides and product rules (medical tariff structure) Intermediate (Operating) system Intermediate Risk Awareness Intermediate Process understanding Intermediate Health Insurance / Medical aid Industry Intermediate
Skills
Skills Level (Basic, Intermediate, Advanced) Attention to detail Intermediate Computer Literacy (basic) and MS Office Intermediate Written and verbal communication skills Basic Root cause analysis and problem solving Intermediate Analytical thinking Basic
EDUCATION
Education Essential / Advantageous Diploma (Minimum) Essential Relevant business certificate Advantageous
Experience
Type of Experience Industry Years Essential / Advantageous Claims assessing Health / Insurance 2 – 3 Essential General administration /data capturing Health / Insurance 2 – 3 Advantageous
BEHAVIOURAL COMPETENCIES
Behavioural success factors that are either pertinent to the role or carried out on a daily basis. These are the observable behaviours or personal attributes (actions, verbal or non-verbal cues) that you would see on a daily basis. Please bear in mind that the 8 chosen are the most important behavioural attributes – the others as listed may well be relevant too although not as essential to daily operations
Behavioural Attributes Ranking Achieving Personal Work Goals and Setbacks Adapting and Responding to Change X Adhering to Principles and Values X Analysing X Applying Expertise and Technology Coping with Pressure and Setbacks X Creating and Innovating Deciding and initiating action Delivering Results and Meeting Customer Expectations X Entrepreneurial and Commercial Thinking Following Instructions and Procedures X Formulating Strategies and Concepts Leading and Supervising Learning and researching Persuading and influencing Planning & organising X Presenting and Communicating Information Relating and Networking Working with People X Writing and Reporting
