Specialist - Claims Payment (direct health claim)

Job Summary

The position is responsible for managing end-to-end claims processing, including registering claims, verifying documentation, assessing policy coverage, and approving claim payments within assigned authority. The role requires direct hands-on experience in claims assessment and payment, ensuring accuracy, compliance, and a high standard of customer service throughout the claims journey.

Key Responsibilities

• Register and open claim cases received from members and healthcare providers
• Verify completeness and accuracy of claim documentation in accordance with company standards
• Assess policy coverage, benefit entitlements, and claim eligibility based on policy terms and conditions
• Approve claim payments within delegated au...