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:

• Delivery exceptional customer experience in all interactions on call and email by maintaining highest level of professionalism.
• Review and approve dental 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.
• Educate insured members about their dental benefits, coverage limitations, and preventive care options to promote health awareness.
• Identify appropriate specialists, services, or community resources that can contribute to the member's overall health and well-being
• Manage urgent or critical cases promptly, coordinating immediate interventions and connecting with emergency services as needed.
• Issuing preauthorization approvals for both out and in patient cases.
• Keep a clear complaint tracker and ensure timely resolution of all complaints and escalations.
• Respond to potential/existing customer intermediaries' inquiries by providing and/or clarifying with the desired information.
• Proficiency in optical terminology and eyecare processes.
• Proficiency in dental data analysis and
• Identify appropriate specialists, services, or community resources that can contribute to the member's overall health and well-being. .
• Proficiency in medical terminology.
• Resolves complaints by clarifying issues and exploring and alternative solutions, implementing solutions, and escalating unresolved complaints. viii. Evaluate the optical healthcare needs, visual history, and current condition of members to develop a clear understanding of their eyecare 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.

Qualifications

• Graduate from a recognized university
• Medical professionals have an added advantage.
• Proficient in the use of Microsoft Office suite and packages

Relevant Experience

• Minimum of 1 year experience in a Call Centre environment.