Employee Benefits Administrator

SUMMARY:
A Healthcare Administration/Employee benefits company is looking for an Employee Benefits Administrator

POSITION INFO:

What the role is accountable for

An employee benefits administrator is responsible for quality assuring and processing various types of claims i.e. death, disability, medical underwriting, exits and funeral. The employee must understand the rules and requirements pertaining to the claim’s timelines and provider requirements

A typical day may include (ideally no more than 10 – 12 characteristics)

-       Quality assure all claim forms received and capture the task on the CRM system,

-       Submitting the completed claim form plus supporting documentation to the provider

-       Following up regularly on the progress of the claim in accordance to provider timelines

-       If there are outstanding information from HR/member, the administrator must follow up on a regular basis until the documentation is received and submit to the provider

-       Updating/saving all correspondence between the member/provider/employer on the CRM system

-       Ensure that all membership movements are implemented on the monthly billing

-       Delays on claims to be escalated to managed

-       Full understanding of the clients benefits and rates per provider

-       Special projects

Qualifications we look for

Essential Qualifications:

-       NQF Level 5 RE

-       FAIS

Preferred Qualifications:

-       NQF Level 5 RE

-       FAIS

Experience we look for

-       Minimum 5 years’ experience in medical scheme membership administration

-       Proficient in advanced Excel 

-       Advanced knowledge on employee benefits rules, FICA, FAIS and TCF

-       Advanced knowledge of employee benefits processes

How the role raises the bar

-       Full understanding of employee benefits, requirements, timelines, and processes

Business Support - Performs a specialised support function in office / professional environment, including clerical / administrative support.  May require vocational training or the equivalent experience

Has working knowledge and skills to perform a defined set of analytical/scientific methods or operational processes.   Applies experience and skills to complete assigned work within own area of expertise.  Works within standard operating procedures and/or scientific methods.  Works with a moderate degree of supervision.

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