Medical Claims Administrator

Neo Batho (Pty) Ltd; Pretoria; On-site; ZAR 210,000 - 260,000; Full time

Job summary

Neo Batho (Pty) Ltd in Bryanston seeks an experienced Medical Claims Administrator to manage the full claims process from intake to documentation and reporting. The role requires handling claims across employee group benefits or medical insurance environments with accuracy and discretion.

The ideal candidate will excel in a structured, detail-oriented environment, liaise with insurers and medical professionals, and ensure timely processing of claims while maintaining data confidentiality.

Qualifications

• Experience in full administration of medical/related insurance claims.
• Excellent attention to detail and accuracy.
• Ability to work under pressure and manage multiple claims.

Responsibilities

• Manage the full administration process for medical and related insurance claims.
• Receive, capture and process claims accurately and efficiently.
• Review claims and ensure all required supporting documentation has been received.
• Follow up on outstanding information required to process claims.
• Liaise with insurance companies, medical professionals, doctors and other relevant parties.
• Communicate with stakeholders regarding claim requirements, progress and outcomes.
• Prepare and maintain accurate claims records and documentation.
• Compile and provide claims-related reports as required.
• Monitor outstanding claims and ensure timely follow-up
• Identify discrepancies or missing information and resolve them appropriately.
• Ensure claims are processed in accordance with procedures and requirements.
• Provide general administrative support relating to the claims function.
• Maintain confidentiality of sensitive medical and personal information.

Skills

Claims administration

Attention to detail

Organisational skills

Stakeholder management

Communication skills

Job description

Introduction

About the Role

A well-established organisation in Bryanston is looking for an experienced Medical Claims Administrator to join their team. The successful candidate will be responsible for managing the full claims administration process, from receiving and assessing claims through to gathering supporting documentation, reporting and liaising with relevant stakeholders.

This role would suit an organised and detail-oriented individual with strong claims administration experience, ideally within employee group benefits, medical insurance or a related insurance environment.

Duties & Responsibilities

Key Responsibilities

• Manage the full administration process for medical and related insurance claims.
• Receive, capture and process claims accurately and efficiently.
• Review claims and ensure that all required supporting documentation and information has been received.
• Follow up on outstanding information required to process claims.
• Liaise with insurance companies, medical professionals, doctors and other relevant parties.
• Communicate with stakeholders regarding claim requirements, progress and outcomes.
• Prepare and maintain accurate claims records and documentation.
• Compile and provide claims-related reports as required.
• Monitor outstanding claims and ensure that matters are followed up within required timeframes.
• Identify discrepancies or missing information and resolve these appropriately.
• Ensure that claims are processed in accordance with relevant procedures and requirements.
• Provide general administrative support relating to the claims function.
• Maintain confidentiality when dealing with sensitive medical and personal information.

Desired Experience & Qualification

Minimum Requirements

• At least 5 years' experience in a similar claims administration role.
• Experience in employee group benefits and/or claims processing is highly advantageous.
• Experience within medical insurance underwriting with claims exposure will also be considered.
• Good understanding of the end-to-end claims administration process.
• Excellent attention to detail and accuracy.
• Ability to work under pressure and manage multiple claims simultaneously.
• Strong organisational and time-management skills.
• Excellent English communication skills, both written and verbal.
• Strong interpersonal and stakeholder-management skills.
• Relevant industry certification will be advantageous but is not essential.
• Must be a South African citizen.