Claims Administrator | Affinity Health

Affinity Health Vacancies – Claims Administrator

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Job Summary

Administer payments of health claims.

Key Responsible Areas

• Process hospital admission and related accounts received.
• Perform administrative duties.

Tasks

Process hospital admission and related accounts received:

• Receive accounts and authorization letters.
• Open accounts received.
• Compare ICD10 codes to determine coverage.
• Process day-to-day claims.

Perform administrative duties:

• Capture notes into relevant folders and claims management system.
• Advise providers/members when maximum benefits have been paid.
• Request decline letters for non-covered conditions/accounts.
• Engage with members/providers regarding queries.
• Contact members regarding their cover, benefit limits, declines, or payment allocations.
• Provide feedback on claim progress.
• Check hospital claims for correctness.
• Send proof of payments to members/service providers.
• File proof of payments and accounts.
• Send out daily statistics.
• Obtain relevant documentation required for applicable benefits.

Essential Qualifications

• Matric.

Essential Experience

• Minimum 2 years in the insurance industry and its products.

Knowledge and Skills

• Excellent administrative skills.
• Knowledge of medical claims handling.
• Knowledge and adherence to policies and procedures relating to hospital claims.
• Knowledge of medical operating systems.
• Excellent computer skills (MS Office, Excel).
• Excellent written and communication skills.
• Time management skills.
• Excellent interpersonal skills.
• Client relationship-building skills.

Attributes

• Patience (to deal with difficult members).
• Positive attitude.
• Ability to multitask.
• Professional demeanor and appearance.
• Team player/works independently.
• High level of enthusiasm.
• Innovative/energetic.
• Ability to work under pressure.
• High degree of commitment.
• Motivated.
• Accuracy.
• Deadline-oriented.
• Honest, hardworking, and humble.