Portuguese Claims Manager (Health Care)

Johannesburg, South Africa | Posted on 06/14/2024

Our client is seeking an experienced Portuguese Claims Manager (Health Care) in Johannesburg (Hybrid / Remote) adept at handling complex issues related to healthcare policies and processes. The successful candidate will manage a team responsible for case management, claims processing, and customer service. This role demands expertise in handling sensitive communications, both verbal and written, along with strong leadership and communication skills to effectively lead a team of claims processors and client service representatives.

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

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.
  

If you are ready to take on a challenging and rewarding role as a Portuguese Claims Manager (Health Care) in Johannesburg (Hybrid / Remote) , we would love to hear from you! Please send your CV through. If you do not receive any feedback within 7 days of your application, please be advised that you were not successful in making the shortlist.