Handling customer queries, complaints, instructions received through call and email communication by:
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 in Nursing or related medical field
3 - 5 years in a similar role
Knowledge of insurance regulatory requirements
Knowledge of Britam products and services
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 a commitment to the organization; 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 organizational values during everyday interactions.