Operations Assistant

Job Summary

To provide Coordinator and fellow team members with the assistance & support required for products &

services sold by the company and also the processes involved.

 Assist with the daily functions of the department.

 Adjudication of Basic Group Health, Vision and Dental Claims for all external clients of the company within the established policy specifications & procedures.

Primary Responsibilities:

1. Adjudication of Group Health Claims

• Ensuring all documents required are submitted i.e. claim forms, receipts, bills, referrals, etc.
• Accurate recording of claim payment information on claim record sheet for insured/patients
• Requesting & following up with additional information requested for claim settlement from clients, brokers, service providers, physicians via letter, telephone, fax, email, financial advisors e.g. APS, reports, breakdowns etc.

2. Claim Data Entry & Email Dispatching

• Entering of all claim information into claim databases i.e. client name, patient(s) name(s), date received, amount claimed, attending physician, amount paid by benefit, payee name, cheque number, cheque date.
• Dispatching of payment notification emails to respective clients.

3. Filing

• Pulling insured's claim files for new claims or queries.
• Creation of claim files using the enrolment documents i.e. enrolment card, declaration of health forms, approval letters and also preparation of claim record sheets.
• Proper re-filing of claim files to their respective filing location in alphabetical order to ensure easy future retrieval.
• Periodic purging of claim file cabinets for removal of terminated insureds/clients and also location of mis-filed claim files.

4. Handling Queries

• Interacting with clients, service providers etc. whether via personal interaction, telephone, email fax or financial advisors and responding to these queries within a reasonable time.

Secondary Responsibilities:

• Receiving and date stamping incoming mail for the Unit.
• Assist with special exercises that may be required from time to time.

Qualifications

Education

Minimum 5 CXC O'Level passes inclusive of Grade 1 or 2  in Mathematics and English A and

6 CAPE passes or an equivalent diploma or professional certificate

Experience

Prior experience in the insurance industry; particularly Group Health

Please note that our recruitment and selection policy requires you to present a police certificate of character no older than 6 months from the date of stamp.

We thank you for your application. However, only if you have been short-listed, you will be contacted.