Position Purpose and Description

 

Perform data entry of cases and bills in accordance with standard operating procedures, ensuring accuracy and compliance. Assess and qualify claims and bills for payment while adhering to established guidelines. Provide fair treatment to clients and customers, delivering excellent service in line with industry and company standards. Additionally, maintain service level agreements (SLAs) to uphold operational efficiency and client satisfaction.

 

KEY RESPONSIBILITIES 

Case assessment and Coordination 

·        Create and register new cases in the system accurately and in a timely manner. 

• Collect accurate information and documents to proceed with a claim, make appropriate decisions and complete tasks based on SOPs.

·        Review and assess claims against policy terms, conditions, exclusions, and limitations.

·        Coordinate and update existing cases, ensuring completeness, accuracy, and compliance with internal processes. 

·        Support cost-control efforts through the accurate validation of medical/service bills and verification of claim authenticity

·        Monitor case progression and proactively escalate complex or high-risk cases to the Team Leader.

Client, Member & Provider Relations 

·        Respond promptly and professionally to all client, member, and service provider inquiries across all communication channels (phone, email, and system-based messaging). 

·        Collaborate with Team Members across other offices to provide accurate information, recommendations, and clarification on claim-related matters to support effective decision-making.

·        Handle claim-related complaints in accordance with established guidelines, policies, and SOPs, ensuring timely and effective resolution.

·        Ensure a consistent, empathetic, and solution-oriented approach when handling sensitive medical situations. 

·        Build and maintain effective relationships with service providers to facilitate smooth case coordination. 

Administrative & Documentation 

·        Upload supporting documents and medical records to claims files as required within established protocols. 

·        Handle and verify incoming invoices in alignment with established procedures. 

·        Maintain accurate and up-to-date records across all case management systems. 

·        Adhere to data protection and confidentiality standards in all case-related activities. 

·        Perform ad hoc tasks and administrative duties as directed by the Team Leader or management. 

Quality & Compliance 

·        Consistently adhere to client-specific SLAs and internal quality benchmarks. 

·        Participate in team meetings, briefings, and performance review sessions. 

·        Contribute to continuous improvement by identifying process gaps and suggesting enhancements. 

·        Remain up to date on product knowledge, internal procedures, and any updates to client protocols. 

SYSTEMS & TOOLS 

System / Tool	Purpose
AutoQ	In-house claims management, client invoicing, and provider payment system
Genesys (formerly Interaction Desktop)	Telephony and multi-channel communication platform
Office 365 (Word, Excel, Outlook, Teams)	Documentation, reporting, internal communication and collaboration

KEY CHALLENGES 

The following represent the most significant challenges inherent to this role, requiring resilience, sound judgment, and strong interpersonal skills: 

·        Operating on permanent morning shifts in a dynamic and fast-paced environment while maintaining consistent service quality. 

·        Managing multiple simultaneous cases across different clients, countries, and urgency levels with competing deadlines. 

·        Coordinating with international medical providers across different time zones, languages, and healthcare systems. 

·        Adapting quickly to evolving client protocols, system updates, and operational changes with minimal disruption to service delivery. 

·        Ensuring accuracy and completeness of documentation under time pressure, particularly during high-volume periods. 

SUCCESS MEASURES & KEY PERFORMANCE INDICATORS

Key Performance Area	Success Measure / KPI - Measurement Parameter	Target to meet
SLA Adherence	100% adherence to client-specific response and resolution SLAs	≥ 98%
Case Accuracy	Case records are complete, accurate, and updated in real time; error rate < 2%	≥ 98%
Response Time	All client/member/provider inquiries acknowledged within defined response time	≥ 98%
Productivity	Number of Live emails / invoices processed	75 per day
Quality Scores	Consistent achievement of quality audit scores	≥ 98%
Escalation Management	Timely and appropriate escalation of complex cases with no missed critical thresholds	≥ 95%
Team Collaboration	Active contribution to team handovers and shift briefings; positive peer feedback	≥ 98%
Continuous Improvement	Participation in process improvement initiatives; documented suggestions or contributions	As required and ongoing

KNOWLEDGE, SKILLS & ATTRIBUTES (KSA) 

Knowledge 

·        Working knowledge of the insurance sector and claims processing.

·        Understanding of health insurance claims processing and SLAs. 

·        Familiarity with European and international healthcare systems and medical terminology. 

·        Knowledge of data protection and confidentiality requirements in a medical/insurance context (e.g., GDPR). 

Skills 

·        Excellent written and verbal communication in English and French; additional languages are an asset. 

·        Strong organisational and multitasking skills with the ability to manage competing priorities. 

·        Basic to Intermediate proficiency in Microsoft Excel (data entry) and Word. 

·        Proficient in case management systems; ability to learn and adapt to new platforms quickly. 

·        Strong problem-solving ability with sound judgment in urgent and high-pressure situations. 

·        Ability to compose clear and professional written correspondence.  

Attributes & Personal Characteristics 

·        Empathetic and client-centric with a genuine commitment to delivering excellent service. 

·        Reliable, accountable, and conscientious – takes ownership of cases through to resolution. 

·        Flexible and adaptable.

·        Collaborative team player who contributes positively to team dynamics and morale. 

·        Demonstrates initiative and proactively seeks solutions rather than waiting for direction. 

·        Resilient under pressure, particularly in time-critical situations. 

·        Attentive to detail with a strong commitment to accuracy and process compliance. 

 

EXPERIENCE & QUALIFICATIONS 

Requirement	Detail
Education	Diploma or degree in a relevant field (Healthcare, Insurance, Business, or related); equivalent experience will be considered
Experience	Minimum 1–2 years of experience in medical case management or a similar client-facing role in healthcare or insurance
Language	Fluency in English and French (written and spoken) is required
Technical Skills	Basic to Intermediate Microsoft Office proficiency; experience with case or claims management systems preferred
Availability