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    Claims Administrator

    Location:South Africa
    Company:Ambledown

    We have a vacancy in Ambledown: Please apply with your updated CV and a one-page motivation letter by the 6th of March 2026.

    Qualifications:                      
    • Clinical Diploma/Degree
    • SANC Registered
    • FAIS Compliant

    Skills and Experience:
    • A minimum of 2 years’ gap cover claims experience
    • Technical knowledge on various health insurance products
    • Advanced knowledge of ICD Codes, medical procedures and medical aid schemes
    • Sound understanding of the Prescribed Minimum Benefits (PMB) legislation in conjunction with gap cover
    • Strong computer skills, including Microsoft Office and intermediate to advanced Excel skills
    • Excellent customer service, communication, and interpersonal skills
    • Advanced Business English (written and verbal)
    • Strong attention to detail and accuracy
    • Analytical and problem-solving skills with the ability to interpret clinical information
    • Ability to take ownership and responsibility for actions and outcomes
    • Ability to handle pressure while remaining calm, professional, courteous, and solution-oriented
    • Experience in dealing with escalated and/or complex claims queries is an advantage
    • Ability to work independently and as part of a team.

    Reporting to:

    Claims Supervisor  

    Scope of Responsibility:
    • Assess claims in accordance with policy rules, benefits, and conditions
    • Conduct clinical review and validation of pre-existing conditions and casualty claims
    • Attend to escalated and complex clinical queries
    • Respond to broker and policyholder queries in a timely and professional manner
    • Ensure compliance with internal policies, procedures, and regulatory requirements
    • Maintain accurate records and documentation of claims assessments and outcomes.
    • Contribute to process improvement initiatives within the claims department.
    • Any other duties as assigned by the company from time to time.

    Changes:

    The company reserves the right to change this job description at its sole discretion from time to time.

    Posted on 30 Mar 16:12, Closing date 6 May

    Apply by email

    hr@ambledown.co.za

    Or apply with your Biz CV

    Create your CV once, and thereafter you can apply to this ad and future job ads easily.
    Ambledown
    For over two decades, Ambledown has been a trusted partner in South Africa’s healthcare landscape, helping individuals and families navigate the financial challenges of medical expenses.

    Disclaimer: This is not a medical scheme, and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.
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