Claims administrator (H/F) – direct billing, assurance santé | Le Kram

MSH Tunisia is hiring : A Claims Administrator - Direct Billing

DUTIES AND RESPONSIBILITIES

Summary:

Process and follow up healthcare claims as well as determining the payable amount of healthcare benefits for the assigned portfolio.

Tasks:

● Check eligibility of the insured and dependents

● Check premium status where necessary

● Check claims as per policy requirements

● Update database with information received

● Record claim reimbursement notices

● Forward payment notices to Claims Manager/Senior Administrator for validation

● Check Providers agreed tariffs in case of direct billing claims

● Capture the medical services with the adequate codes

● Forward high amount claims to the medical team for evaluation

QUALIFICATIONS

Education:

● Bachelor's degree in business, accounting or finance, insurance designation, or medical field preferred but not required

Computer Skills:

● Microsoft office knowledge is a must

Languages:

● English, French & Arabic mandatory

Necessary Skills & Abilities:

● Detail oriented and committed to a high degree of accuracy

● Ability to work within a team environment

● Good communication skills (oral & written)

● Promptness and efficiency

● Organization skills

● Customer service skills

● Ability to listen and reassure customers