Ex Gratia Administrator - Temp MMH

Role Purpose

To prepare cases to be reviewed by the Client's Ex Gratia Committee Board members.

• Grade 12 or equivalent
• Relevant Degree or Diploma in a clinical field (Advantageous)

• Relevant Degree or Diploma in a clinical field (Advantageous)

• Basic knowledge of claims and reading filters
• 2 - 3 years medical aid experience
• 2 - 3 years client service experience
• Extensive computer experience on Ms Word, Ms Excel and Outlook

• Excellent communication skills (Written and Verbal)
• Ability to interact with a range of stakeholders in a professional manner
• Client service orientation
• Perform under pressure in a deadline driven environment
• Ability to work independently and to function effectively within a team
• Excellent planning, time management and organising skills

• Perform administrative duties and provide a professional service to members, where special grants are requested in cases where medical expenditure, in excess of the Scheme's limits, has caused and or would cause financial hardship for members.
• Establish and maintain knowledge of Ex Gratia Guidelines and mandates, Scheme Rules,Benefit Exclusions and Claims operational systems.
• Process all documentation received from members, service providers, Managed Care Service providers and the Scheme or Principal Officer accurately and timeously and confidentially.
• Record and assesses the Ex gratia Application Form and supporting documentation for completeness.
• Makes telephonic contact with the member to acknowledge receipt of the form.
• In the event of an incomplete Ex gratia Applications and/or outstanding supporting documentation, request the member to send the outstanding documents
• Perform claims investigation and reconciliations to ensure that all claims are processed correctly, and refer to Claims department for correction where necessary.
• Refer applications to the relevant managed care organisation (MCOs) for validations where applicable.
• Cancel the Ex gratia application as per standard operating procedure (SOP), should the requested information not be received.
• Accurately investigate and prepare Ex Gratia cases for presentation by the Ex Gratia Manager to the Ex Gratia Committee, comprising of the Scheme's Board of Trustees andthe Scheme officials.
• Educate and guide members regarding their benefits to enhance understanding and satisfaction with their benefit options.
• Take ownership of escalated and unresolved queries and ensure they are resolvedtimeously and effectively.
• Ensure the effective, accurate and timeous completion of relevant documentation accompanying applications.
• Provide clear communication to all parties involved in an investigation with regards to the outcomes and process.
• Ensure Service Level Agreements are met and exceeded
• Maintain high standard of quality ensuring all cases are prepared accurately.
• Provide and maintain accurate and thorough telephonic information to members, service providers and Business Partners regarding queries for claims and general client services relating to Ex Gratia.
• Finalise and communicate meeting outcomes for members and draft outcome letters.

• Build and maintain relationships with clients and internal and external stakeholders.
• Deliver on service level agreements applicable to clients and internal and external stakeholders in order to ensure that client expectations are managed.
• Make recommendations to improve client service and fair treatment of clients within areaof responsibility.
• Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.
• Continuously monitor turnaround times and quality standards and resolve issues speedily to enhance client service delivery.
• Drive client service delivery goal achievement in line with predefined standards in order toensure that clients receive appropriate advice and after sales service.
• Manage client query processes and ensure that queries are tracked, accurately resolved and used as a mechanism to improve client service and business processes.

• Build strong relationships through providing specialist know-how and leadership to others,expressing positive expectations.
• Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialisation.
• Positively influence and manage change and offer specialist support where required.
• Contribute to continuous innovation…