Claims Administrator – Health

About the role

The Claims Administrator – Health ensures that all electronic and physical health claims, as well as related correspondence, are accurately routed and processed within the organisation. This role supports both internal teams and external stakeholders, maintaining high standards of data integrity and service delivery.

Key responsibilities

• Prepare claims in line with departmental standards to enable timely processing.
• Validate member and provider details and organise claims into appropriate batches.
• Scan and route claim and correspondence batches to the relevant departments.
• Investigate and resolve internal and external enquiries within SLA, providing written or verbal feedback.
• Compile and analyse claim‑related reports using Excel.
• Verify member and provider information and source missing data for swift claim handling.
• Liaise with providers to confirm cover and benefits when required.

Required profile

• Diploma or relevant business certificate (minimum).
• 2–3 years experience in claims assessing or general administration within health/insurance.
• Intermediate knowledge of medical tariff guides, product rules, and health insurance processes.
• Strong attention to detail and ability to work under defined timelines.

Required skills

• Excel
• MS Office