As a Medical Benefits Officer, you will Support the Manager in pre-approval operations and ad hoc project work across the department to ensure adherence to company policies, standard operating procedures and regulatory authorities mandates. In all areas, maximise the use of automation to limit company expense and improve efficiency. Ensure that Medical Benefits (MB) policy and procedures are upheld in all operational activity. Administrate projects, scheme updates and process revisions in line with MB objectives and management direction ensuring accurate documentation of process and policy change in line with audit parameters. Support management reporting with reports and dashboards. 

In this role, you will:

• Support claims, pre-approvals and customer support teams across medical and administrative operations to ensure they are operated effectively within the MB team thereby ensuring consistency. Work with the Manager to identify and monitor quality and establish problem areas and implement corrective action.


• Maintain a consistent business process review approach making maximum use of automation to improve speed and quality of internal processes and the customer experience.


• Compile feedback from various sources thereby measuring external medical providers and healthcare benefits, documenting and investigating to seek recommendations for quality improvements.


• Process pre-approvals and medical claims to determine cover in line with company terms and conditions. Make decisions with regards to payment, denials, investigations and reimbursement ensuring that company policies and regulations have been accurately applied within the set time frames.


• Authorise urgent medical claims and/or medical treatment at external medical providers within set SLAs. Procedures need to be reviewed regularly and, where required, escalate external provider trends to ensure our employees are given an excellent standard of medical care and internal support. Authorise approvals, reimbursements and direct billing invoice payments in-line with the applicable Medical Benefits Manual.


• Correspond and communicate via telephone, email or personal visits with covered members, doctors, internal stakeholders and external medical providers to discuss and resolve matters relevant to effective claim and pre-approval processing and business operations.

To be considered for the role, you must meet the below requirements:

• Degree or Honours (12+3 or equivalent) in a relevant business field with relevant experience (medical insurance HR policy, projects etc.)


• 2+ years of experience in a similar role

You'll have an edge if you have:

• Knowledge of claim examination procedures and standard insurance procedures.


• Knowledge of medical terminology is desirable.


• Knowledge of company insurance schemes and the reimbursement and benefits system would be an advantage.


• Proficient in written and spoken English.


• Computer literate and proficient in the MS Office Suite of Software with advanced Excel skills. 
  Preferred knowledge of web based tools such as SharePoint and Business Intelligence