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Key Objective
The position is responsible for the delivery of best practice claims operations, consistent delivery of services within target levels, relationships with suppliers/stakeholders, management and reconciliation of the net claims expense budget and ownership of the customer experience.
Key Accountabilities & Responsibilities
Assessment of Group and Individual hospitalisation and surgical claims – reimbursement basis.
Auditing cashless claims for Group and Individual hospitalisation and surgical claims.
Overseeing and facilitating payment processing for bordereaux medical claims.
Performing sanctions checks on all relevant parties and ensuring that all claims are in compliance with both internal and external regulatory requirements.
Keeping constant communication with management and underwriting teams.
Providing feedback on any visible claims trends.