Your key job responsibilities as the Portuguese Claims Manager (Health Care) in Johannesburg (Hybrid / Remote) will include:
- Supervise the timely and accurate processing of medical insurance claims.
- Establish and maintain quality assurance measures.
- Ensure claims audits for accuracy, completeness, and compliance with insurance policies and regulations.
- Manage service delivery and case management, focusing on claims risk management.
- Translate and analyze medical reports and other information in the context of case management.
- Review and control risk processes related to claims underwriting.
- Develop and implement strategies to enhance overall customer experience and satisfaction.
- Ensure staff are trained on claims processing procedures, insurance policies, and regulatory requirements.
- Communicate effectively with insurance carriers, healthcare providers, and policyholders to resolve claims-related inquiries.
- Lead, mentor, and coach teams of claims processors and customer service agents to ensure high performance and productivity.
Requirements for this Portuguese Claims Manager (Health Care) job in Johannesburg (Hybrid / Remote):
- Matric with a tertiary degree or diploma in Nursing, Healthcare Administration, or other medical qualifications.
- Fluency in English and Portuguese (spoken and written).
- Experience working in a fast-paced claims environment and capable of building relationships.
- Strong communication skills and high levels of accuracy.
- Excellent leadership and team management abilities, with a proven track record of building and motivating high-performing teams.
- Minimum of 5 years of experience in medical insurance claims processing, with at least 2 years in a supervisory or managerial role.
- In-depth knowledge of medical insurance policies, procedures, and regulations.
- Proficiency in using claims processing software and other relevant computer applications.
- Proficiency in Microsoft Office and Outlook.
