Job Ref. No: JHIL104

Role Purpose

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

Main Responsibilities

Operational

• Delivery of exceptional customer experience in all interactions on call and email by maintaining the 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 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, and 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 Competencies

• Empathy skills
• Listening skills
• Verbal communication
• Adaptability 
• Attention to detail.
• Good Interpersonal relationships
• Ability to multi-task
• Proficiency in optical terminology and eyecare processes.
• Proficiency in dental data analysis and interpretation.
• Proficiency in medical terminology.

 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.