If this vacancy is of interest to you, please send a CV to email@example.com or give us a call on 0208 549 7212.
Main purpose of the job including responsibilities
Working in liaison with the Health Services team and reporting to the Administration Manager. The Medical Claims Administrator will provide daily administration within the company, ensuring a professional and high standard of customer service at all times.
Key activities/main duties
- On a daily basis open the post, scan and allocate to the CMS system efficiently in order to avoid a backlog.
- Process invoices using EDI (electronic data interchange) Veda billing.
- Deal with provider queries or requests in relation to clinical treatment or pre-authorisation requests.
- Process invoices received in-line with agreed service standards, member benefit limits and policy terms and conditions.
- Manage Claims administration reminders and outstanding actions.
- Assess invoices received to ensure costs are in line with provider contract terms.
- Maintain and document accurate records within the Case Management System including: all invoice or claim related payments, and all communication with members and providers.
- Audit provider invoices in line with company reasonable & customary rates (where appropriate).
- Escalate any complaints or call backs in a timely manner to the Administration Manager or Senior Administrator.
- Communicate directly with members, clients, providers and other members of the company as required.
- Undertake other business activities and tasks as required ensuring ongoing operational effectiveness, efficiency and positive contribution to the company.
Requirements, background, skills (hours, travel etc.)
- Strong customer focus with excellent verbal and written communication skills.
- A positive, helpful attitude, willing to work co-operatively with other members of the team.
- PC skills with good knowledge of Microsoft packages and the ability to effectively manage computer technology, typing and word processing.
- The ability to demonstrate customer led thinking.
- Good commercial awareness with the ability to make decisions with the “bigger picture” in mind.
- Ability to identify when it becomes appropriate to escalate a problem.
- Strong diplomatic communicator at all levels; verbally and written to build and maintain internal and external relationships.
- Able to demonstrate critical independent thinking and the ability to multi-task in situations where in the outcome is time sensitive.
- A high degree of accuracy and attention to detail.
- Effective time management to be able to multi-task, prioritise to meet varying tasks and deadlines.
- Highly adaptable, with a flexible approach to work, willing to do what is required to ensure that the team achieves its objectives while remaining focused on quality.
- A pro-active approach to work with analytical problem solving skills.
- The ability to plan and organise own workload, and work well under pressure.
- The ability to work well both independently and as part of a team.