Senior Claims Operations Manager - Medical Aid

Private Health Administrators (Pty) Ltd; Centurion; On-site; ZAR 334,800 - 502,200; Full time

Job summary

A leading healthcare administration company in South Africa is seeking a Claims Processing Manager to effectively manage the claims processing department. The successful candidate will ensure accurate and timely processing of claims, oversee staff performance, and handle escalated customer inquiries. A minimum of 5 to 8 years of management experience in a medical aid administration environment, along with a tertiary qualification in a related field, is required. The role also involves enhancing service quality and compliance with regulations.

Qualifications

• 5 to 8 years of management experience in a medical aid administration environment.
• Ability to implement quality control procedures and ensure compliance with regulations.
• Competence in preparing and presenting performance reports.

Responsibilities

• Oversee daily operations of the claims department ensuring accurate processing.
• Supervise and evaluate performance of claims staff.
• Handle escalated customer inquiries and complaints.
• Ensure claims process compliance with scheme rules.
• Develop improvements to enhance claims processing efficiency.

Skills

Leadership

Analytical skills

Communication

Proficiency in claims management software

Attention to detail

Education

Tertiary qualification in related field

Tools

Microsoft Office Suite (Excel, Word, PowerPoint)

Job description

A leading healthcare administration company in South Africa is seeking a Claims Processing Manager to effectively manage the claims processing department. The successful candidate will ensure accurate and timely processing of claims, oversee staff performance, and handle escalated customer inquiries. A minimum of 5 to 8 years of management experience in a medical aid administration environment, along with a tertiary qualification in a related field, is required. The role also involves enhancing service quality and compliance with regulations.