Our client in the Insurance Industry is looking for a Clinical Risk Consultant / Claims Authorisation expert for their healthcare claims division.
Salary is negotiable depending on experience.
Job purpose: Clinical Risk Management by underwriting, authorisation according to protocol, case management and claim auditing. Provide support and education to clients/providers relating to claims and claim queries. Project a professional company image through customer/provider interaction
Clinical Risk Management
- Underwriting according to protocol and to ensure effective risk management
- Authorisation of claims based on policy terms and conditions
- Timeous and accurate assessing of claims
- Maintain customer/provider relations
- Assist with staff and provider training and support
- Answer phones and respond to customer requests within the determined SLA.
- Explain products and update customer details in computer system
- Provide customers with product and service information via appropriate methods (telephonically/ email)
- Identify, research, and resolve customer issues using the computer system
- Follow-up on customer enquires not immediately resolved, within determined SLA’s
- Complete call logs and reports
- Educate clients on claims process.
- Assist and resolve claim queries.
Competencies required: Knowledge, Skills & Attributes
Knowledge
- Relevant B-degree/ diploma
- Literacy- read and write English and at least 2 official languages
- Pc Literacy- word, excel, email and internet
- Minimum 3 years working experience in a claims department
- Pass technical competence test
- Meets FAIS Fit & Proper requirements as per requirements
Desired Skills:
- Healthcare
- Claims
- Claims Authorisations
- FAIS
- RE
- Insurance
- Claims Administration
Desired Work Experience:
- 2 to 5 years
Desired Qualification Level:
- Diploma
About The Employer:
Our client is based in Woodmead