Insurance Specialist

ROLE SUMMARYThe Insurance Specialist is responsible for the execution of assigned insurance claims activities for SuperCare within Health & Beauty. The role is responsible for accurate and timely claim validation, submission, resubmission, follow-up, and record maintenance under approved procedures, with exceptions and unresolved issues escalated to the line managerROLE RESPONSIBILITIESValidate assigned claims against approved insurer requirements, coverage, supporting documents, and billing details; resubmission of claims, reconciliation of claims, obtain corrections or missing information from stores before submission.Submit complete claims through approved systems within agreed timelines and maintain submission acknowledgements and transaction records.Track pending rejected and unpaid claims; correct routine errors and resubmit eligible claims within insurer deadlines and approved procedures and ensure payments are made as per the agreed time periods.Conduct routine follow-ups with insurers and healthcare providers on assigned cases; escalate disputed, recurring, or overdue items to the Line Manager with supporting evidence.Maintain accurate claim, rejection, and payment trackers; match remittance details to claims and share discrepancies with Finance and the Line Manager for resolution.Prepare operational reports on assigned claims, rejection reasons, ageing, and outstanding payments for the Line Manager, flag risks to deadlines and recoverability.Apply approved insurance procedures, confidentiality requirements, and record controls; compile documents and evidence requested for audits and reviews.Provide stores with case-specific documentation guidance and approved process instructions; refer policy interpretation and training needs to the Line Manager.Suggest practical improvements based on recurring processing issues and implement changes approved by the Line Manager.ROLE REQUIREMENTSBachelor’s degree with 4 years of relevant healthcare or pharmacy insurance claims experience. Insurance or claims management certification is an advantage.Claims systems experienceInsurer documentation requirements, rejection handling, payment tracking, Excel reportingAttention to detail and stakeholder coordination.