Medical Aid Service coordinator – Senior (Medical Aid) – KZN Durban

ESSENTIAL FUNCTIONS

• Loading/checking/updating cases on internal client relationship systems (DCP and BIAS), including new activations and terminations, queries and underwriting
• Flexi care activations each month
• Submit Terminations each week and month
• Ensure that all membership movements are implemented on the monthly billing
• Respond to member queries where necessary
• Work through induction packs each month and identify member applications for medical aid
• Submitting medical aid applications to the schemes and follow ups
• Cross check terminations with activations each week and month
• Assist with provident fund withdrawal claims, ensuring all documentation is complete prior to submission for Admin Department – main claims processing function being done in JHB office
• Following up regularly on the progress of the claim in accordance to provider timelines
• If there is outstanding information from client HR/member, follow up on a regular basis until the documentation is received and submitted to the provider
• Delays on claims to be escalated to managed
• Full understanding of the clients benefits and rates per provider
• Special projects

EXPERIENCE REQUIRED

• Minimum 3 to 5 years’ experience in medical scheme membership administration
• Proficient in advanced Excel, Outlook, internal systems and team expectations
• Knowledge of employee benefits structures (Pension, Provident, Life cover Disability Benefits), FICA, FAIS and TCF – a bonus to have
• Full understanding of medical aids and employee benefits, requirements, timelines, and processes

WORK ENVIRONMENT

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

Category 3:  Has working knowledge and skills developed through formal training or work experience.  Works within established procedures with a moderate degree of supervision.  Identifies the problem and all relevant issues in straightforward situations, assesses each using standard procedures and makes sound decisions

Essential Qualifications:

• 3 to 5 years medical aid experience – either in Medical Aid Administrator or with an FSP – with relevant training certificates

Preferred Qualifications:

• 3 to 5 years medical aid experience
• NQF Level 5 RE
• FAIS