Claims Manager

Position Purpose: Effective management of the claims processing department, ensuring that claims are handled accurately, efficiently, and in line with the policies and guidelines of the medical aid scheme. Managing the financial risk associated with claims, enhancing the quality of service to members, and protecting the sustainability of the medical aid scheme.

Experience: 5 to 8 years’ solid management experience within a medical aid administration environment.

Qualifications: Tertiary qualification in related field.

KEY PERFORMANCE AREAS

Claims Processing

• Oversee the day-to-day operations of the claims department.
• Ensure timely and accurate processing of medical aid claims in accordance with scheme rules.
• Review and authorize high-value or complex claims.
• Monitor and manage claim adjustments, denials, and appeals.

Team Management

• Sup...