Clinical Claims Specialist - Gap Cover & PMB Expert

Ambledown Financial Services; Johannesburg; On-site; ZAR 300 000 - 500 000; Full time

Job summary

A financial services company in Johannesburg is seeking a Senior Claims Administrator with a strong clinical background. The role involves authorising claims, conducting clinical reviews, and ensuring compliance with regulations. Candidates should have a Clinical or Nursing Diploma, be SANC registered, and possess 2-3 years of experience in gap cover claims. Strong attention to detail and excellent customer service skills are crucial for this position.

Qualifications

• Clinical or Nursing Diploma / Degree required.
• SANC Registration necessary.
• FAIS Compliance is advantageous.
• Strong attention to detail and accuracy is essential.

Responsibilities

• Authorise assessed claims according to policy rules.
• Conduct clinical review of pre-existing conditions.
• Respond to broker and policyholder queries professionally.
• Contribute to process improvement initiatives.

Skills

2 – 3 years' gap cover claims experience

Technical knowledge of health insurance products

Advanced knowledge of ICD Codes

Excellent customer service skills

Strong attention to detail

Analytical and problem-solving skills

Strong organisational skills

Education

Clinical or Nursing Diploma / Degree

SANC Registration

Tools

Microsoft Office

Excel (intermediate to advanced)

Job description

A financial services company in Johannesburg is seeking a Senior Claims Administrator with a strong clinical background. The role involves authorising claims, conducting clinical reviews, and ensuring compliance with regulations. Candidates should have a Clinical or Nursing Diploma, be SANC registered, and possess 2-3 years of experience in gap cover claims. Strong attention to detail and excellent customer service skills are crucial for this position.