Departments

Membership and Contributions

  • All membership related queries are handled here i.e. joining, resignation, cards issuance, account queries (payments and reconciliations)

Claims

  • Claims processing and refund to providers and members
  • Payment and remittance advice

Foreign Claims

  • Authorisation of optical claims and adjudication
  • Receiving foreign claims and conversion of all foreign claims including adjudicating foreign drugs, claim forms for onward transmission to the drugs department

Adjudication

  • Attending to members with queries re-admissions
  • Doing specialists and dental quotations
  • Doing adjudication of all claims before they are forwarded for capturing

Drugs

  • Correcting drug tariffs
  • Dealing with drug award queries and pharmacy award queries
  • Prescription processing i.e. drugs bought cash and on medical aid with pre authorisation
  • Capturing of drug claims

Accounts

Day to day supplier expenditure payments

Queries and inquiries

  • First port of call.
  • Receiving MBRS/ Clients
  • Directing client to the relevant section/ telephones to the relevant section.
  • Dealing with claims queries from MBR and providers of service.
  • Receiving cash and ensuring that cash is banked at the appropriate time.

Marketing

  • Maintaining the visibility of the society through creation of adverts.
  • Presenting the society‚Äôs packages to interested organisations.
  • Ensuring that the society grows in membership through innovative marketing strategies.