The role holder will be responsible for answering calls in a professional and informative manner and CRM case logging as necessary. Provide timely and appropriate responses to clients and/or assign tickets to the right person or department.
Key responsibilities:
- Handling customer queries, complaints, instructions received through call and email communication.
- 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.
- Maintains and improves quality results by adhering to standards and guidelines while recommending improved procedures with a QA score target.
- 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.
- Delegated Authority: As per the approved Delegated Authority Matrix.
Key Performance Measures:
As described in your Personal Scorecard.
Knowledge, experience and qualifications required
- Degree/ Diploma in Nursing or related medical field.
- 3 – 5 years in a similar role.
- Knowledge of insurance regulatory requirements.
- Knowledge of Britam products and services.
