Overview
Claims Clerk Mozambique MMH260625-90 Jobs in Maputo, Cidade de Maputo, Mozambique at Guardrisk
Title: Claims Clerk Mozambique MMH260625-90
Company: Guardrisk
Location: Maputo, Cidade de Maputo, Mozambique
Role Purpose
To assess, review and manage living benefit claims in accordance with relevant legislation, scheme/product rules and company policies, while meeting service level agreements and client expectations.
Requirements
- Grade 12 or relevant qualification
- 1–2 years' claims processing experience
- Knowledge of claims assessment, regulations and product rules
- Strong analytical, communication and problem-solving skills
- High attention to detail and customer focus
Duties and Responsibilities
- Assist directly the Claims Team Leader and Ops Manager if necessary.
- Processing claims submitted by health service providers for less than 10 days that include.
- Assessment of claims as per the rules and protocols.
- Close batch reconciliation.
- Achieve expected daily/weekly productivity.
- Report irregular cases on claims assessment.
- Reprocessing and monitor claims of reconciliation process.
- Monitor electronic submission of all health service providers through e-mail and system.
- Processing South African claims.
- Processing In-hospital claims.
- Manage Claims express line.
- Claims quality review of 5% of processing;
- Provide feedback to the internal audit if required.
- Report system errors to claims supervisor and interact with back office if necessary.
- Report all suspected fraud cases to Claims Supervisor and Ops Manager
- Support Claims team leader on monthly reporting, until the 3rd day of the month.
- Claims monthly report
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