Manager ( Pre-Auth and Claims Department)

at  National Risk Managers Pty Ltd

A Medical Insurance company based in Benoni is looking for a Manager to Manage the Pre-Auth and Claims department. The Manager will manage the accurate and timely processing of claims within established legal and company compliance guidelines. Manage the pre-authorisation department and facilitate the process of pre-authorisation as per requests from members for procedures and admissions.

ESSENTIAL QUALIFICATIONS

• Matric
• Business Degree (e.g. B. Com, B.Sc. etc)
• FAIS Compliant (RE1 and RE5)
• Clinical Qualification
• SANC Registration

DESIRABLE QUALIFICATIONS

• Accounting or Finance qualification
• Pre-authorisation and case management or relevant managed healthcare experience
• Microsoft Excel Intermediate or Advanced Certificate

ESSENTIAL EXPERIENCE

• 3 years management experience within the financial services environment
• 5 years’ experience in the insurance industry or similar environment e.g. Healthcare
• Experience in the implementation of business change and optimisation projects
• Insurance and/or medical aid experience

DESIRABLE EXPERIENCE

• 2 years insurance industry experience

KNOWLEDGE AND SKILLS

• Knowledge of claims processing, approval
• Knowledge of business policies, processes and procedures, legal compliance
• Expert technical knowledge involving coverage and contract interpretation
• Liability issues analysis experience
• Claim litigation management skills
• Experience in mediation/arbitration and dispute resolution management
• Numerical skills
• Negotiation and persuasion skills
• Networking skills
• Business Acumen
• Customer Centric
• Relationship building skills
• Excellent organisational skills
• Excellent written and communication skills
• Time management skills
• Excellent interpersonal skills
• Client relationship-building skills
• Directing and Controlling skills
• Staffing skills

PERFORM GENERAL ADMINISTRATION DUTIES.

• Develop roster in line with operational plans and or schedules
• Generate reports on performance of the department
• Prepare and submit periodic reports