Medical Aids Administrator - Service Co-ordinator Cape Town

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 we look 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 Our client looks 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