Senior Health Claims Specialist

Key Responsibilities

• Assess and settle valid health claims within turnaround times and policy guidelines.
• Monitor and follow up on pending claims promptly.
• Manage customer complaints effectively, including face-to-face resolution.
• Support and / or conduct training on claims processes.
• Generate claims statistics and reports.

To ensure compliance with regulatory and risk management controls, corporate policies and claims procedures, fair dealing outcomes, and all relevant laws and regulations.

This role requires strong analytical skills to assess and settle claims accurately and efficiently. The successful candidate will have excellent communication skills to manage customer complaints effectively.

The ideal candidate will be able to work independently to meet service standards and deadlines.

A well-established process for managing health claims ensures the most efficient and effective use of resources.

Skillful claim assessment and settlement is crucial in this role, requiring a thorough understanding of relevant policies and procedures.