Job Description:
Receive calls from members or employer groups, providers and prospective clients
To receive calls from providers and have first call resolution on pre-authorization queries for limited and straight forward cases or route the query to the correct department for call resolution
To receive Employer group calls and to resolve queries relating to the specific group or members within the group and route the query to the correct department for call resolution in the more complex cases
To receive and resolve all member related calls and to ensure that all complaints and queries are resolved on first call resolution or escalate the query for resolution
To receive calls from prospective clients and re-route the calls to the Sales and Distribution department ensuring that het prospective clients receive the best service
To log enquiries for all calls relating to registered providers, Clients and members
To follow up on specific cases as distributed by the manager to ensure a value added service offering
To adhere to and live the organizational values
Requirements:
Candidate must be a registered nurse, midwife or possess B.Sc. Nursing with valid license.
Candidate must have a minimum of Credit or Second Class Upper Division and additional medical qualification will be an added advantage
Candidate must have minimum of 1 year clinical experience and experience in similar role in a Health Maintenance Organization (HMO) will be an added advantage
Candidate must have advanced knowledge of NHIS regulatory guidelines, Medical Global Best Practices, Health Insurance, Products and Processes, and Scheme Rules
Excellent organizational, communication (verbal and written), listening skills and attention to detail.
Candidate must be very proficient in Microsoft office packages
Other requirements:
Good organizational and planning capabilities
Innovative and quick thinking capabilities
Innovativeness
Adaptive
Decision Making skills
Integrity
Ability to work under pressure
Adaptive, expertise, Result-Oriented, Relationship Skill
Working with people
Must be a good collaborator/Team player
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