The role holder will be responsible for handling customer queries, complaints and instructions received through call and email communication
Key responsibilities
- Interact with clients , intermediaries and service providers to ensure that the care is given within policy guidelines;
- Set the appropriate parameters for admission cases i.e. claim reserve, initial authorized cost , cover benefits and duration;
- Respond to queries from clients, intermediaries and service providers through answering telephone calls, interviewing clients and verifying information.Liaise with underwriters on scope of cover for the various schemes benefits ;
- Ensure that medical scheme members are attended to round the clock;
- Prepare periodic care reports for management on medical matters/ issues;
- Perform any other duties as may be assigned from time to time;
- Maintains and improves quality results by adhering to standards and guidelines; recommending improved procedures with a QA score target 95%;
- Ensure clients outpatient approvals are issued via email as per SLA;
- Facilitate admissions and discharges appropriately;
- Maintains communication equipment by logging in interactions through CRM for traceability / visibility;
- Maintain and monitor telephone budget allocation to ensure lines are diverting to E1 lines; and
- Deliver on performance requirements as defined in the departments’ strategy map, balanced scorecard and Personal Scorecard.
Knowledge, experience and qualifications required
Diploma or Degree in Nursing or related medical field
3 – 5 years in a similar role
Knowledge of insurance regulatory requirements
Knowledge of Britam products and services
Essential Competencies
- Learning and Researching: Rapidly learns new tasks and commits information to memory quickly; demonstrates an immediate understanding of newly presented information; gathers comprehensive information to support decision making at management level; learns from successes and failures and seeks colleague and customer feedback.
- Working with People: Shows respect for the views and contributions of other team members; shows empathy; listens, supports and cares for others; consults others and shares information and expertise with them; builds team spirit and reconciles conflict; adapts to the team and fits in well.
- Applying Expertise and Technology: Applies specialist and technical expertise; uses technology to achieve work objectives; develops job knowledge and expertise (theoretical and practical) through continual professional development; demonstrates an understanding of different organisational departments and functions.
- Delivering Results and Meeting Customer Expectations: Focuses on customer needs and satisfaction; exhibits high standards for quality and quantity; monitors and maintains own quality and productivity; works in a systematic, methodical and orderly way; consistently achieves projects goals.
- Following Instructions and Procedures: Follows procedures and policies; keeps to schedules; arrives punctually for work and meetings; demonstrates commitment to the organisation; complies with legal obligations and safety requirements of the role.
- Adhering to Principles and Values: Upholds ethics and values; demonstrates integrity; accepts diversity; display individual responsibility towards the community and the environment; models the organisational values during every day interactions.
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