Senior Case Manager – Call Centre (First Assurance Kenya)

Job Summary

To provide efficient and effective customer service to customers with utmost consistency and quality, ensure customer excellence, and facilitate access to quality, safe, effective and cost-efficient care for insured clients. Respond to customer enquiries and address issues regarding products or services at the 24-hour contact centre.

Job Description

Key Responsibilities

• Immediate management of inbound and outbound calls in line with contact center call guidelines/etiquette and provide solutions to customers in a professional way within the stipulated TATs.
• Guide the insured Members about their benefits management, the appropriate service providers and other related member benefit matters.
• Problem-Solving and Decision-Making: addressing complex customer issues and providing accurate information to ensure customer satisfaction.
• Technical or Customer-Facing Responsibilities: Handling technical aspects of customer interactions, utilizing CRM system and ensuring a seamless customer experience.
• Attend to client’s enquiries i.e., answering calls, responding to emails from customers, regarding membership eligibility, coverage, approval status, benefit information and case approvals and/or denials.
• Ensure medical pre-authorizations/undertakings/approvals/declines are issued in compliance with the policy provisions, authority limits and TATs.
• Receive customer complaints or queries and document the same.
• Follow through and resolve escalated customers and provider queries and complaints in time and advise them on outcome and the details of the medical product.
• Escalate unresolved cases and follow through for their resolution and ensure customer satisfaction.
• Perform outbound calls and follow up post hospitalization clients for service feedback and enrollment to the chronic disease management program (CDMP).
• Advise members on how best to utilize their benefits by recommending cost effective facilities and cheaper options e.g., maternity packages, chronic management.
• Negotiate rates and ensure recoveries from third parties like Social Health Authority are affected.
• Scheduling the call center staff for 24-hour coverage based on rotation, hours worked and workload distribution.
• Continuous identification of service gaps and implementation of corrective measures.
• Observe confidentiality of client information and compliance with the Data Protection Act.
• Handle any other official tasks assigned by the line manager.

Knowledge Management

• Improve technical knowledge through self-learning or training including mandatory Continuous Professional Education requirements.
• Share knowledge with colleagues and peers in the business.
• Develop and enhance learning through seeking coaching, training and continual feedback.

Reporting

• Sending daily admissions reports to clients; Brokers/Agents/company Human resource managers.
• Prepare and compile section reports on daily, weekly and monthly basis and forwards to the management.

Relationship Management

Develop and maintain relationships with colleagues and clients; Brokers/Agents/company Human resource managers.

Education, Experience Required and Competencies

Education

Bachelor’s Degree/Diploma in Nursing (KRCHN)/ Clinical Medicine/ Health Management or in a related field with up-to-date license.

Experience

Minimum 2 years of clinical experience and 3 years case management experience.

Technical Skills

Proficiency in CRM software, Microsoft Office Suite.

Soft Skills

Excellent communication skills, empathy, negotiations, collaboration, problem-solving abilities, adaptability and a customer-centric approach.

Industry Knowledge

Understanding of insurance policies, regulations, compliance and standards.

Licensing

Licensed by relevant statutory regulator in his/her respective medical field.