Claims Associate Representative (GHB) - Provider Service Organisation

Role Overview

This position is responsible for the day-to-day processing, validation, and correction of claim data received from partner organisations. You will work within predefined rules and standard operating procedures to ensure data accuracy in the policy administration system, raising IT tickets for issues that cannot be resolved directly. The role serves as an entry point into administrative operations, supporting the integrity of automated data feeds and helping maintain smooth claim processing workflows.

Key Responsibilities

• Generate, sort, and categorise weekly reports by error code, updating tracking logs to maintain a clear view of workload progress.
• Apply standard corrections in the policy administration system for common data issues such as member numbers, diagnosis or procedure codes, service dates, partner IDs, and billing amounts.
• Follow rule-based instructions for each error category, performing fixes where possible and routing items to IT for more complex cases.
• Raise IT tickets and escalate to the supervisor for issues like duplicate closures, forced claim loads, invalid data entries, or adjustments that fall outside standard correction steps.
• Handle adjustment and reconciliation reports by documenting claim references, preparing tracking sheets, and reprocessing or reversing claims according to defined procedures.
• Own the shared mailbox for escalated cases, ensuring responses and resolutions are completed within agreed turnaround times.
• Maintain accurate documentation by adding standard claim comments, archiving reports and logs as per SOP, and identifying opportunities to improve mapping, reporting, or processes.
• Support additional administrative tasks as business needs require.

Requirements & Qualifications

• High attention to detail and accuracy when working with structured data and repetitive tasks.
• Ability to follow step-by-step procedures without deviation and apply rule-based logic consistently.
• Comfortable working across multiple internal systems simultaneously.
• Basic proficiency in Excel: sorting, filtering, adding columns, and organising data into tabs.
• Strong organisational skills to manage a daily or task-by-task workload efficiently.
• Proficient with standard Microsoft Office applications.
• English language skills sufficient for clear written and verbal communication with internal stakeholders.
• Previous experience in administrative operations, data entry, or shared-services environments is beneficial but not required.
• Diploma or degree in Business, IT, or a medical-related field is required.