Job Ref. No: JHIL191

Role Purpose

The job holder will be responsible for attending to intermediary, customer, and providers queries by determining their requirements, answering to these inquiries, resolving problems, and fulfilling customer’s requests. The holder will be required to ensure excellence in all customer interaction and offer memorable experiences.

Key Responsibilities

Operational

Delivery exceptional customer experience in all interactions on call and email by maintaining highest level of professionalism.

Manage urgent or critical cases promptly, coordinating immediate interventions and connecting with emergency services as needed.

Issuing preauthorization approvals for all outpatient, dental, optical, and inpatient cases.

Keep a clear complaint tracker and ensure timely resolution of all complaints and escalations.

Respond to potential/existing customer and intermediaries’ inquiries by providing and/or clarifying with the desired information.

Identify appropriate specialists, services, or community resources that can contribute to the member's overall health and well-being.

Resolves complaints by clarifying issues and exploring answers and alternative solutions, implementing solutions, and escalating unresolved complaints.

Evaluate the healthcare needs, history, and current condition of members to develop a clear understanding of their healthcare requirements.

Ensure strict process compliance in line with the business lines objective.

Selling additional products by recognizing opportunities to cross-sell or up-sell new benefits.

Maintain and improve quality results by adhering to standards and guidelines, recommending improved procedures.

Generate reports on the various engagements and feedback collected. Contribute to quality improvement initiatives by providing insights and feedback to enhance care processes and outcomes.

Collaborate with dental professionals, specialists, and providers to coordinate and facilitate comprehensive dental care for insured members.

Review all treatment plans, ensuring they align with medical guidelines, member needs, and insurance coverage.

Engage with insured members to explain treatment options, address concerns, and support them throughout their healthcare journey.

Identify appropriate specialists, services, or community resources that can contribute to the member's overall health and well-being.

Key Skills and Competencies

Demonstrated empathy and understanding in handling client concerns.

Actively listening to accurately identify and address customer needs.

Adaptable to changing systems, policies, and client needs.

Attention to detail in data entry, policy interpretation, and documentation.

Ability to multitask interactions and tasks efficiently.

Clear understanding of optical terminology and eyecare benefit processes.

Proficiency in interpreting dental records and benefit structures accurately.

Conversant with medical terminology to explain benefits and claims clearly.

Academic & Professional Qualifications

Graduate from a recognized university

Medical professionals have an added advantage.

Proficient in the use of Microsoft Office suite and packages.

 Relevant Experience

A minimum of 1 years’ experience in a Call Centre environment