COID and RAF Claims Administrator

SUMMARY:
Seeking an experienced Claims Administrator with good knowledge of COID and RAF Claims

POSITION INFO:

Process hospital admission and related accounts received.

• Receive accounts and GOP’s.

• Opening accounts received.

• Compare ICD10 codes to determine if it’s a condition we cover or an exclusion.

• Send day to day accounts to PAMC.

• Perform administrative duties

• Capture notes into the relevant folders and claims management system.

• Advise the Providers/ Members when maximum benefits have been paid.

• Request decline letters for conditions/ accounts not covered.

• Engage with Members/ Providers regarding their queries.

• Contact Members when they are unsure about their cover, benefit limits, declines or payment allocations and provide them with detailed statements or reports.

• Provide Members, Agents or Service Providers with feedback with regards to the claim progress.

• Check hospital claims for correctness (completed in full).

• Send proof of payments to Members/ Service providers.

• File POP’s and accounts.

• Send survey information to the Customer Care Supervisors weekly.

• Send out daily statistics.

• Check that the death claim forms are accompanied by the relevant documentation.

• Obtain all the relevant documentation required for the dread disease benefit.

 

NB! This job is now closed. You can apply for other jobs by uploading your CV.

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