About the position
A well-established company is recruiting for a
REGIONAL WALK-IN AGENT
BLOEMFONTEIN
PURPOSE OF THE JOB
The purpose of the role is to provide support in resolving all walk-in referred and e-mail enquiries received within a self-administered medical scheme environment. Liaise with members, brokers and healthcare professionals, delivering an exceptional customer service.
DUTIES AND RESPONSIBILITIES, AMONGST OTHERS INCLUDE:
- Attend to and resolve walk-in client queries, referred or e-mailed queries in a professional manner to members, brokers and health care professionals and effectively resolve queries and/or escalate queries to the relevant stakeholder when required.
- Investigate the various stakeholder queries, reconcile claims and provide comprehensive feedback as per the Standard Operating Procedures (SOP's) and quality standards and/or escalate queries to the relevant stakeholder when required.
- Attend to membership new application queries, verify application completion and collect all required documents before submission to the Membership division.
- Provide advocacy to members regarding requirements for terminations or amendments.
- Provide advocacy and support to members on Scheme products and services.
- Assist in resolving finance related queries, and/or refer to the dispute broker or provider for investigation.
- Assist in resolving credit control queries, refer payment to credit control division for investigation, and escalate accordingly regarding suspension, proof of payment, arrears, allocations of payment, and reconciliations.
- Conduct an analysis of the quote to provide the customer with pricing guidelines. Assist in resolving special clinical cases by investigating ex gracia, prescribed minimum benefits (PMB) cases, and ensure that all relevant documents are collated before escalating to relevant stakeholders.
- Assist new business with the coordination of events, deal with clients face to face using all available resources to resolve queries.
- Navigate, generate, upload and update all member, broker and heath care provider requests.
- Educate and communicate with internal and external stakeholders to obtain information and provide feedback.
- Facilitate all internal and external stakeholder interventions to determine outcome.
- Ensure that queries that are not resolved on contact are correctly referred to the relevant division.
- Record customer complaints regarding overall customer experience.
- Record client visits, reconcile office credit card and maintain daily running of the Regional office.
- Assist in identifying and adhering to fraud controls, risk prevention principles, sound governance and compliance processes, and tools to identify and manage risks.
- Support and provide evidence to internal, external and ISO audit requirements.
- Maintain quality and risk management standards in line with the requirements from ISO9001:2015.
- Maintain and enforce all quality assurance related Service Level Agreements to minimise business risk and ensure business continuity.
QUALIFICATION & EXPERIENCE
- Matric
- 3 years Medical Aid industry experience
Please send your cv and supporting documents to [Email Address Removed].
If you have not received any feedback within 2 weeks please assume that your application was not successful
Desired Skills:
