Medical Claims Supervisor at Old Mutual

The Medical Claims Supervisor at Old Mutual is responsible for overseeing the claims processing department, ensuring that all medical claims are processed accurately, efficiently, and in accordance with company policies and regulatory requirements. This role involves supervising staff, optimizing claims workflows, providing training, and liaising with healthcare providers and other stakeholders to resolve claims-related issues.

Key Responsibilities:

Supervise and mentor claims processing team members, providing guidance on best practices and addressing any performance issues.
Conduct regular team meetings to discuss updates, share knowledge, and foster a collaborative team environment.
Ensure timely and accurate processing of medical claims by monitoring workflows and implementing process improvements.
Review and approve claims to ensure compliance with internal policies and regulatory standards.
Coordinate the investigation and resolution of complex claims issues, including denials and appeals.
Ensure timely and accurate processing of medical claims by monitoring workflows and implementing process improvements.
Review and approve claims to ensure compliance with internal policies and regulatory standards.
Coordinate the investigation and resolution of complex claims issues, including denials and appeals.
Perform regular audits of claims processed by the team to ensure accuracy and compliance with company standards.
Identify areas for improvement in claims processing and implement corrective actions as necessary to reduce errors and minimize losses.
Perform regular audits of claims processed by the team to ensure accuracy and compliance with company standards.
Identify areas for improvement in claims processing and implement corrective actions as necessary to reduce errors and minimize losses.
Perform regular audits of claims processed by the team to ensure accuracy and compliance with company standards.
Identify areas for improvement in claims processing and implement corrective actions as necessary to reduce errors and minimize losses.
Perform regular audits of claims processed by the team to ensure accuracy and compliance with company standards.
Identify areas for improvement in claims processing and implement corrective actions as necessary to reduce errors and minimize losses.

Skills

Excellent leadership and team management skills.
Strong analytical and problem-solving abilities.
Proficient in claims processing software and Microsoft Office Suite.
Exceptional communication and interpersonal skills.

Education

Bachelor’s degree in nursing / clinical medicine and surgery or Business related Degree
Diploma in Nursing / Diploma in Clinical Medicine and Surgery. (Registered Nurse/Clinical Officer
CoP & Data Analytics (will be an added advantage)

Experience