VAC-9064 Medical Claims Handler

Cape Town

Organization: CTG - Committed To Good
Location: Cape Town
Grade: Level not specified - Level not specified
Occupational Groups:
- Operations and Administrations
- Medical Practitioners
- Children's rights (health and protection)
Closing Date: Closed

Job description

CTG overview	CTG staff and support humanitarian projects in fragile and conflict-affected countries around the world, providing a rapid and cost-effective service for development and humanitarian missions. With past performance in 17 countries – from the Middle East, Africa, Europe, and Asia, we have placed more than 20,000 staff all over the world since operations began in 2006. CTG recruits, deploys and manages the right people with the right skills to implement humanitarian and development projects, from cleaners to obstetricians, and mechanics to infection specialists, we’re skilled in emergency response to crises such as the Ebola outbreak in West Africa. Key to successful project delivery is the ability to mobilise at speed; CTG can source and deploy anyone, anywhere, in less than 2 weeks and have done so in 48 hours on a number of occasions. Through our efficient and agile HR, logistical and operational services, CTG saves multilateral organisations time and money. We handle all our clients’ HR related issues, so they are free to focus on their core services. Visit www.ctg.org to find out more
Overview of position	CTG will establish a Global Security Operations Centre (GSOC), providing a 24 / 7 response capability to support the in country teams to manage crisis & respond to incidents. The Medical Claims Handler will form part of the response team & assess & determine eligibility for medical claims submitted by CTG consultants & permanent staff. This is a role for someone who is medically qualified with experience working in challenging environments.
Role objectives	Assigned as but not limited to: Form part of the core team to provide 24 / 7 coverage in the response centre. Support in country teams to respond to incidents & crisis management. Filter & coordinate emergency medical requirements to our medical partners & follow up. Examine claims records & forms to determine eligibility of medical claims. Process claims & respond to claimants within the agreed Service Level Agreement (SLA). Ensure reimbursement of claims is swift & efficient, with clear communications through the process (eg if more documentation is required). Complete logs, reports, forms & records to properly document medical claims. Adhere to all company policies, procedures & guidelines in determining eligibility for claims. Examine medical treatment records & supporting evidence to gauge overall extent of liability. Interview & communicate with claimants, CTG permanent staff, physicians & other necessary individuals to decide claim denial, settlement or review. Implement initiatives to reduce illegible & fraudulent claims. Ensure all claims information remains confidential. Monitor & routine report on medical claims expenditure & budgets. Engage in continuing education & training opportunities when possible with CTG permanent staff. Review & suggest improvements to the CTG claims management platform (Tayo). Track CTG’s claims loss ratio against budgeted premiums & report on a monthly basis.
Project reporting	This role reports to the below 2 line managers: GSOC Lead Global Risk Manager.
Key competencies	Bachelor’s Degree in a Medical field (essential). Recognised qualification from an insurance institute (desirable). Minimum of 5 years of practicing medical experience (essential) Previous experience handling medical claims (essential). Minimum of 3 years of experience in complex or conflict afflicted environments (essential). Fluent in English (essential). Working knowledge of French or Arabic (desirable). Technical knowledge of claims management process. Strong written & verbal communication skills. Collaboration. Critical thinking. Financial acumen. Time management.
Team management	This role has no team management responsibility.
Further information	Qualified female candidates are encouraged to apply for this role.
Disclaimer: At no stage of the recruitment process will CTG ask candidates for a fee. This includes during the application stage, interview, assessment and training.