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Claims Service Representative (In-Patient) at Health SGL at Swan

Port Louis, Port Louis, Mauritius -

Full Time

Start Date

Immediate

Expiry Date

17 Sep, 26

Salary

0.0

Posted On

19 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claim Handling, Medical Coding, Fraud Detection, Customer Service, Policy Analysis, Interpersonal Communication, MS Office, Data Verification, Stakeholder Management, Time Management

Industry

Financial Services

Description

Main Responsibilities * Claim handling: Clinic admission notifications, filtering, coding, verification, data capture and processing of Claims * Guide / Coach Claims Teams with respect to the medical aspects of claims * Detect fraudulent or unwarranted items / treatment claimed * Assist In-Patient team in claims handling: input, verify & review data on IT system * Liaise with Service Providers and Medical Consultants * Provide assistance and information to clients and doctors at clinics’ help desk * Follow-up of incoming calls, mails and queries in a timely manner * Communicate with PCL and respond to PCL queries * Liaise with the different stakeholders and department teams * Liaise with in-house Medical Officers * Provide feedback to Coordinator/Team Leaders/Head of Claims and assist them in daily duties * Any other cognate duties that may arise. Qualifications and Experience * Holder of a Higher School Certificate (HSC) or equivalent. * Have at least 2 years Health Insurance and/ or General Insurance Market Knowledge and Practice * Some medical knowledge and/or experience in the medical insurance sector would be an advantage * Be customer-oriented. * Be proactive, dynamic and result oriented. * Well versed in policy wording, policy terms and conditions. * Good interpersonal and communication skills (both oral and written). * Be able to handle pressure to deliver against tight deadlines. * Be a team player. * Have an outgoing personality with good communications skills. * Be well conversant with MS Office Tools (including PowerPoint) and with passion to excel. The Company reserves the right: 1. To convene only the best qualified candidates to participate in the selection exercise. 2. Not to make any appointment following this advertisement.

Responsibilities

Responsible for processing in-patient claims, including coding, verification, and fraud detection. The role involves liaising with medical consultants and service providers to ensure accurate claim handling and client support.