About the position
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.
Key Areas of Responsibility
- 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 [URL Removed] 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 [URL Removed] 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.
- Review related Standard Operating Procedures in consultation with the Supervisor and Manager: Support Services to ensure business optimisation.
- Adhere to all relevant laws, policies and Standard Operating Procedures throughout the organisation.
- Build and maintain effective internal and external stakeholder relationships for the purpose of expectations management, knowledge sharing and integration.
- Provide support to the Scheme's business units when required to achieve business goals.
EXPERIENCE AND QUALIFICATIONS
- 3 Years Medical Aid Industry experience is ESSENTIAL
- MATRIC
Desired Skills:
- MATRIC
- MEDICAL AID INDUSTRY EXPERIENCE
- WALK-IN OR CUSTOMER SERVICE
