Medical Aid Services Co-ordinator senior post Durban

Position Job title

MEDICAL AIDS SERVICE COORDINATOR – KZN Durban - Senior

Division

Employee Benefits Company specialising in Medical Aids

Business area

Closing date

10 FEBRUARY 2022

Salary grade/level/family/range— including minimum and maximum pay bands.

R28 000

Type of role:

Permanent

Position type and expected hours of work

FULL TIME – 5DAYS PER WEEK – 8H00 TILL 17H00

Position Location

KZN Durban

Qualification Essential Competency

Essential Qualifications:

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

Qualification preferred education and experience

Preferred Qualifications:

-      3 to 5 years medical aid experience

-      NQF Level 5 RE

FAIS

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.

Travel

Yes

What type of person

A Team Player who does not need to be chased for performance.

A desire to grow into a fully capable Medical Aid and Employee Benefits Consultant

What the role is accountable for

Medical Aid Consultant to be capable of servicing clients in the absence of the Consultant and growing into a full Consultant Role across multiple clients.

Administration function: Handling the medical aid administration and Flexicare billing, i.e. handling all financial changes to be submitted to the schemes and follow ups/escalations if necessary. Checking the billing statements on 10 and 15^th of each month to ensure that those changes are done.

Liaison with the clients to ensure that the billing is accurate and timeously maintained.

Basic functions with respect to Employee Benefits

Role reporting

Cape Town Consultant and Senior Consultant JHB

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

-      Loading/checking/updating cases on internal client relationship systems (DCP and BIAS), including new activations and terminations, queries and underwriting

-      Flexicare 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

Qualifications our client looks for

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

Experience we look for

-      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

How the role raises the bar

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