Job Ref. No: JHIL104
Role Purpose
The job holder will handle inquiries from intermediaries, customers, and providers by understanding their needs, addressing their questions, resolving issues, and fulfilling requests. The role holder is expected to provide excellent service in all customer interactions and create memorable experiences.
Main Responsibilities
Delivery exceptional customer experience in all interactions on call and email by maintaining 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 with 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, 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
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 or hold a diploma in nursing from a recognized medical teaching institution.
Proficient in the use of Microsoft Office suite and packages
Relevant Experience
Minimum of 1 year experience in a Call Centre environment.
If you are qualified and seeking an exciting new challenge, please apply via Recruitment@jubileekenya.com quoting the Job Reference Number and Position by 5 th May 2024
Apply via :
Recruitment@jubileekenya.com
