Jobs
Unity Health Recruitment 2023/2024
Applications are invited from interested and suitably qualified candidates for Unity Health Recruitment 2023/2024.
Unity Health Toronto is a Catholic hospital network serving Toronto, Ontario, Canada. It was initially founded in 2017 under the provisional name Our Shared Purpose through the merger of St. Michael’s Hospital, Providence Healthcare and St. Joseph’s Health Centre.
We are recruiting to fill the following position below:
Page Contents
Job Title: Claims Supervisor
Introduction
We have a unique opening for a Claims Supervisor to join our team
Unity Health is a well-established primary healthcare provider in the South African market. Our mission is to offer primary healthcare insurance solutions to the vast majority of South Africans unable to afford medical scheme coverage.
Duties & Responsibilities
- Managing the Claims division according to agreed standards and ensuring that high service levels are maintained
- Identifying gaps within the department and mitigating risk
- Liaising with external and internal parties
- Reporting on claims risk utilisation/profiling
- Creating standard operating procedures and business rules
- Validating and processing claims according to policy conditions, benefit, and business rules, manually or electronically, for all practice types
- Administering claims, business rules, standard operational processes, claims improvement, as well as data quality management within the claims department
- Training for current and new staff when needed
- Completing daily workflow processes within SLA
- Effectively and professionally managing correspondence or claim queries received within SLA
- Investigating and resolving complaints and escalation
- Leading and motivating the claims team
- Monitoring compliance requirements of the claims
- Providing technical support, mentoring, and coaching to staff
- Ongoing QA and KPA assessments of staff
- Producing reports on team performance, claims and other report requests from management
- Contributing positively to the business culture
- Any other duties as assigned by your manager from time to time
Desired Experience & Qualification
Qualifications:
- Matric
- Diploma or equivalent
- FAIS Compliant
- Customer Service Certificate
- RE:5 Certificate
Skills and Experience:
- At least 3-5 years’ experience in a similar role
- Solid leadership and people management skills
- Sound understanding of the South African Medical aid or Health insurance industry
- MIP Administration System knowledge preferrable
- Intermediate knowledge of ICD codes, RPL tariffs and medical procedures
- Knowledge of claim modifiers
- Knowledge of provider claims assessment
- Good understanding of electronic claim submissions via switching houses and bureaus
- Strong interpersonal skills and the ability to engage various parties appropriately for optimal outcomes
- Ability to work within an established team
- Excellent written and communication skills –business English
- Adaptable – fast learner and shows a positive response to change
- Excellent analytical skills
- Excellent computer skills – MS Office a must
- Resilient: must be able to work under pressure, remain calm, professional, and willing to assist
- Incorporating the principles of Treating Customers Fairly (TCF)
Package & Remuneration
Market-Related
Disclaimer
The company reserves the right to change this job description at its sole discretion from time to time.
How to Apply
Interested applicants should kindly visit the company website to get more details and submit the application(s).