Job Description:1 Receive calls from members or employer groups and providers and prospective clients2 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 resolution3 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 cases4 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 resolution5 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 service6 To log enquiries for all calls relating to registered providers, Clients and members7 To follow up on specific cases as distributed by the manager to ensure a value added service offering8 To adhere to and live the organizational valuesRequirements:• Candidate must be a registered nurse and midwife• B.Sc. Nursing and additional medical qualification will be an added advantage• Candidate must have minimum of 3 years medical experience including 2 years in similar role in a Health Maintenance Organization (HMO)• Candidate must have Clinical or General Nursing and Insurance Call Centre experience• 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 packagesOther 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• Strategic• Must be a good collaborator/Team player
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