Medical Aid administrator \ Services Co-ordinator

ESSENTIAL FUNCTIONS
Loading/checking/updating cases on internal client relationship systems (DCP and BIAS), including new activations and terminations, queries and underwriting
Flexi care activations each month
Submit Terminations each week and month
Ensure that all membership movements are implemented on the monthly billing
Respond to member queries where necessary
Work through induction packs each month and identify member applications for medical aid
Submitting medical aid applications to the schemes and follow ups
Cross check terminations with activations each week and month
Assist with provident fund withdrawal claims, ensuring all documentation is complete prior to submission for Admin Department main claims processing function being done in JHB office
Following up regularly on the progress of the claim in accordance to provider timelines
If there is outstanding information from client HR/member, follow up on a regular basis until the documentation is received and submitted to the provider
Delays on claims to be escalated to managed
Full understanding of the clients benefits and rates per provider
Special projects


EXPERIENCE REQUIRED
Minimum 3 to 5 years experience in medical scheme membership administration
Proficient in advanced Excel, Outlook, internal systems and team expectations
Knowledge of employee benefits structures (Pension, Provident, Life cover Disability Benefits), FICA, FAIS and TCF a bonus to have
Full understanding of medical aids and employee benefits, requirements, timelines, and processes


WORK ENVIRONMENT

Business Support - Performs a professional specialised support function in office and at client sites, including clerical / administrative support. May require vocational training or the equivalent experience.

Category 3: Has working knowledge and skills developed through formal training or work experience. Works within established procedures with a moderate degree of supervision. Identifies the problem and all relevant issues in straightforward situations, assesses each using standard procedures and makes sound decisions.



QUALIFICATION

Essential Qualifications:

3 to 5 years medical aid experience either in Medical Aid Administrator or with an FSP with relevant training certificates

QUALIFICATION AND EXPERIENCE

Preferred Qualifications:

3 to 5 years medical aid experience

NQF Level 5 RE

FAIS