Website Mauritius Union Group
MUA offers an enriching, unique and collaborative work experience. If you believe in results and are looking for challenges, Don't wait and join us today!MUA operates within the financial services industry specialising in short-term and long-terminsurance, offering corporate and individual clients an array of pension, investment, savings andstockbroking solutions.The group comprises five subsidiaries. MUA Life Ltd, MUA Pension Ltd, MUA Mutual Fund Ltd andMUA TransAfrica Holdings Ltd are fully owned subsidiaries. The group also owns an 80% stake inMUA Stockbroking Ltd.MUA Life Ltd is our subsidiary dedicated to life insurance products. MUA Pension specialises in theimplementation and management of pension funds for enterprises. MUA Mutual Fund is a fundmanagement company which focuses on two collective investments schemes. MUA Stockbrokingprovides stockbroking services and is a member of the Stock Exchange of Mauritius Ltd.Since 2014, MUA is also present in East Africa through its acquisition of MUA TransAfricaHoldings Ltd. With headquarters in Nairobi (Kenya) the subsidiary also has offices in Tanzania,Uganda and Rwanda. 4, Léoville L`homme Street, Port Louis, Mauritius 2075500
To assess medical claims and Communicate with members and providers to clarify information and resolve claim-related queries.
Job SummaryTo assess medical claims and PEC/ GOP requests submitted by members and providers, determine coverage while ensuring fairness, accuracy and customer satisfaction as per Terms and Conditions and medical protocol. Communicate with members and providers to clarify information and resolve claim-related queries.Main Responsibilities Keep track records of all incoming requests, claims and emails for reporting purposesEnsure follow-ups are done according to case priority and KPIEscalate urgent and complex matters for quick decision-making and resolutionAssess client’s eligibility for coverage based on applicable limits and the policy ‘Terms and Conditions’Discuss/ review cases with the Medical Advisors Communicate GOP approval or rejection within KPIReview final bills and reports at time of discharge to confirm final GOP amount and any disallowed itemsReconcile, handle and process claims for prompt reimbursement to client according to KPIsIdentify and report any suspicious/ fraudulent claims and/or malpracticeEvaluate SOA from service providers/ partners and ensure payment as per SLAsLiaise with client/ source for any additional information requiredFollow up with Internal Departments, Agents and Brokers in case of queriesAssist walk-in clients and customers for their claim submission for complex casesCollaborate with service providers or partners to place GOP and coordinate timely evacuations and/ or repatriationsConduct regular meetings with service providers, partners and stakeholders to address queries and outstanding casesEngage with medical practitioners, legal counsels and concerned authorities for case reviews and counter examinationsOutlining number of claims/ requests handled as per set target on a daily basisOutline the number of outstanding claims/ requests and payments to service providers/ partnersEscalate any complex, suspicious or problematic caseJob RequirementsHSC/Baccalaureate with at least 2 years relevant working experienceProactive with the aptitude to work in a collaborative environmentAdaptability to changeAbility to work under pressure and according to tight deadlinesComputer literateExperience in the Claims handling and Insurance Terms and ConditionsKnowledge of the medical field and protocolsGood communication skills (verbal and written)The company reserves the right to call only the qualified candidates for the selection exercises. Applications received after the closing date might not be considered. The company also reserves the right not to proceed with the vacancies.
4, Léoville L`homme Street, Port Louis, Mauritius
Phone: 2075500
Apply Via:
recruitment@mua.mu
To apply for this job email your details to recruitment@mua.mu