The benefits clerk is responsible for prompt and accurate administrative support, including the efficient management of claims payments and providing quality customer service to claimants, intermediaries, providers, and team members under the direction of the Medical Supervisor and Management.
KEY DUTIES AND RESPONSIBILITIES
- Daily Intimating and/or log all medical claims on the medical application.
- Prepare and dispatch all Explanation of Benefits (EOB) to intermediaries, agents, and direct clients and policyholders.
- Ensure timely resolution of queries received daily within the medical department is completed as per established
service standards.
- Attend to all daily walk-in clients and call-in clients.
- Prepare and dispatch cheques daily to intermediaries, agents, clients, and policyholders. This includes cheque
payments to healthcare providers.
- File and upload all documents used electronically within the administration and claims function on the applicable
SharePoint site.
- Submission of cheque stubs to Head office for their records upon receipt.
- Prepare pickup forms for cheque disbursement to brokers and agents as required.
- Prepare coverage letters requested by clients and intermediaries within the established service standards and
turnaround time.
- Prepare guarantee letters to Healthcare providers as required for sign off by the Supervisor.
- Generate and prepare any reports (monthly, quarterly, semi-annually, annual, and/or ad hoc) for intermediaries,
agents, and clients, upon request or as required.
- Demonstrate a thorough knowledge of the Company’s products and procedures, and a good understanding of industry
regulations as it relates to the provision of information and services to clients.
- Provide prompt and quality Customer Service by projecting and demonstrating a high level of professionalism,
courtesy, and initiative in accordance with established service standards and policies.
- To perform any other job-related duties as assigned by Management.
KNOWLEDGE & EXPERIENCE
- Minimum 1-2 years’ working experience in an administrative function or medical environment.
- Must exhibit strong communications and interpersonal skills with the ability to effectively communicate with people at
all professional levels, specialties, and roles.
- Must be flexible, analytical, and organized in putting policy changes into practice.
- Good reading and writing skills.
- Clear written and verbal communication with both internal and external clients;
- An ability to work individually and as part of a team.
- Must show good planning, time management, and organizational skills, paying keen attention to detail and the ability
to focus for long periods.
- Demonstrates solid judgement and discretion working with confidential information.
- Deadlines focused; able to work under pressure to meet tight deadlines.