Purpose of the position:
The call centre agent is responsible to administer incoming product support or attend to information enquiries from clients. Handling of incoming calls, assisting with accounts enquiries, member requests, and/or other support issues. Attending to all email and WhatsApp requests from members, service providers and internal parties. Verifying the member’s information and ensuring confidentiality.
Responsibilities and duties:
Membership Related Queries
- Adding or removing of dependants
- Emailing/Faxing membership related forms to members or relevant employer group’s HR department or allocated broker consultant e.g cancellations forms, application forms, change of option form, changes in membership status form etc.
- Processing medical scheme membership medical card requests and ensuring that it will be delivered to the correct address.
- Sending membership certificates when required.
- Sending tax certificates to members during tax season.
- Submitting all member requests for updates in personal information to membership.
- Assisting providers by submitting their updated information to membership to be amended on the system.
Claim related Queries
- Submitting all claims received from members and providers via fax or email to the claims department.
- Assisting members/providers with queries regarding rejected claims, explaining the reasons for rejection and follow up measures to be taken for re-processing of their claims.
- Assisting members/providers with queries regarding short paid claims, explaining the reasons for any shortfall and follow up measures to be taken for re-processing of their claims.
- Submitting claims to the audit department as requested.
Authorisation, Hospital, and Risk Management
- Assisting members, providers, employer HR personnel, broker consultants with the process of obtaining an authorisation for secondary and tertiary healthcare services
- Assisting members and providers with queries relating to a member’s admissions
- Assisting members/providers with challenges relating to TTO medicine following discharge from hospital.
Pharmaceutical Benefits and Disease Management
- Assisting members with all acute/chronic queries
- Following up on the progress of the chronic condition registration
- Following up on the delivery of the chronic medication and giving feedback to members as to when delivery can be expected
- Assisting members/service providers who experience challenges at pharmacies for OTC medication.
- Assisting members who paid cash for medication on how to claim for reimbursement.
- Assisting members/service providers to complete the forms and advising on what supporting documents are required to register on Disease management programmes
Product & Benefit Related Queries
- Confirmation of benefits on all options to member’s and providers
- Educating members on their option and the scheme rules and exclusions
- Promoting the product to potential clients
- Continuous member education on all calls
Candidate Requirements
- 3 – 5 years call centre experience within a medical scheme or insurance environment
- General Business acumen
- Time management skills – follow up – must be able to establish procedures to monitor that, which has been promised and delivered
- Proficient in the use of the Microsoft (MS) Office suite of products, specifically MS Outlook, MS Excel and MS Word
- Excellent interpersonal skills
- Excellent telephone skills
- Excellent listening skills
- Excellent verbal and written communication skills
- Problem solving skills
- Essential qualifications: Matric
- Desirable qualifications: Post matric studies/qualification will be an advantage.
Click here to apply: https://www.careers24.com/jobs/adverts/2104499-medical-call-centre-agent-pretoria-pretoria/?jobindex=2
