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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.
- 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 the 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 line.
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
How To Apply