Medical Claims Assistant

Claims Backlog Clearance:

Support the reconciliation and sign-off of pending claims to meet the three-month backlog clearance target, ensuring accuracy and adherence to policy

guidelines.

Claims Review and Processing:

Evaluate and process inpatient and outpatient claims in line with Britam’s

policies, clinical standards, and documentation requirements.

Customer and Provider Engagement:

Liaise with service providers and clients to ensure medical care is delivered

within covered limits, while managing expectations professionally and promptly.

Claims Compliance:

Review claims and medical reports to ensure compliance with scheme benefits

and clinical appropriateness.

Claims Verification and Audit:

Conduct verification and audits of submitted claims to minimize fraud, errors,

and misuse.

Documentation Management:

Track, follow up, and validate all necessary documentation to complete claims

processing within the required turnaround time.

Reporting and Data Management:

Maintain accurate records of claims transactions, prepare claims registers, and

contribute to periodic reporting and performance tracking.

Delegated Authority:

Act within the scope defined by the approved Delegated Authority Matrix.