Job purpose:

• The role holder will be responsible for answering calls in a professional and informative manner and CRM case logging as necessary. Provide timely and appropriate responses to clients and/or assign tickets to the right person or department.

Key responsibilities:

• Handling customer queries, complaints, instructions received through call and email communication.
• Interact with clients, intermediaries  and service providers to ensure that the care is given within policy guidelines.
• Set the appropriate parameters for admission cases i.e. claim reserve, initial authorized cost, cover benefits  and duration.
• Respond to queries from clients, intermediaries and service providers through answering telephone calls, interviewing clients and verifying information. Liaise with underwriters on scope of cover for the various schemes benefits.
• Ensure that medical scheme members are attended to round the clock.
• Prepare periodic care reports for management on medical matters/ issues.
• Maintains and improves quality results by adhering to standards and guidelines while recommending improved procedures with a QA score target.
• Ensure clients outpatient approvals are issued via email as per SLA.
• Facilitate admissions and discharges appropriately.
• Maintains communication equipment by logging in interactions through CRM for traceability / visibility.
• Maintain and monitor telephone budget allocation to ensure lines are diverting to E1 lines.
• Delegated Authority:  As per the approved Delegated Authority Matrix.

Key Performance Measures:

• As described in your Personal Scorecard.

Knowledge, experience and qualifications required

• Degree/ Diploma in Nursing or related medical field.
• 3 - 5 years in a similar role. 
• Knowledge of insurance regulatory requirements.
• Knowledge of Britam products and services.