Medical Claims Assistant

 Job Purpose:
To support the effective and timely reconciliation, processing, and payment of BMI medical claims, ensuring quality and cost-effective care for clients. The role also includes contributing to the resolution of the current claims backlog within a defined period, while maintaining high standards of accuracy, customer service, and policy compliance.

Key Responsibilities:

• Claims Backlog Clearance:
  Support the reconciliation and sign-off of pending claims to meet the three-month backlog clearance target, ensuring accuracy and adherence to policy
  guidelines.
• Claims Review and Processing:
  Evaluate and process inpatient and outpatient claims in line with Britam’s
  policies, clinical standards, and documentation requirements.
• Customer and Provider Engagement:
  Liaise with service providers and clients to ensure medical care is delivered
  within covered limits, while managing expectations professionally and promptly.
• Claims Compliance:
  Review claims and medical reports to ensure compliance with scheme benefits
  and clinical appropriateness.
• Claims Verification and Audit:
  Conduct verification and audits of submitted claims to minimize fraud, errors,
  and misuse.
• Documentation Management:
  Track, follow up, and validate all necessary documentation to complete claims
  processing within the required turnaround time.
• Reporting and Data Management:
  Maintain accurate records of claims transactions, prepare claims registers, and
  contribute to periodic reporting and performance tracking.
• Delegated Authority:
  Act within the scope defined by the approved Delegated Authority Matrix.

 Knowledge, Experience, and Qualifications Required:

• Bachelor’s degree in Business Administration or related field.
• Excellent attention to detail.
• Good interpersonal and communication skills.
• Ability to work under pressure and meet tight deadlines.
• Proficiency in Microsoft Office and medical claims systems.