Job Description

• Immediate management of inbound and outbound calls in line with contact center call guidelines/etiquette and provide solutions to customers in a professional way within the stipulated TATs.
  
• Guide the insured Members about their benefits management, the appropriate service providers and other related member benefit matters.
  
• Problem-Solving and Decision-Making: addressing complex customer issues and providing accurate information to ensure customer satisfaction.
  
• Technical or Customer-Facing Responsibilities: Handling technical aspects of customer interactions, utilizing CRM system and ensuring a seamless customer experience.
  
• Attend to client’s enquiries i.e., answering calls, responding to emails from customers, regarding membership eligibility, coverage, approval status, benefit information and case approvals and/or denials
  
• Ensure medical pre-authorizations/undertakings/ approvals /declines are issued in compliance with the policy provisions, authority limits and TATs
  
• Receive customer complaints or queries and document the same.
  
• Follow through and resolve escalated customers and provider queries and complaints in time and advise them on outcome and the details of the medical product.
  
• Escalate unresolved cases and follow through for their resolution and ensure customer satisfaction.
  
• Perform outbound calls and follow up post hospitalization clients for service feedback and enrollment to the chronic disease management program (CDMP).
  
• Advise members on how best to utilize their benefits by recommending cost effective facilities and cheaper options e.g., maternity packages, chronic management.
  
• Negotiate rates and ensure recoveries from third parties like Social Health Authority are affected.
  
• Scheduling the call center staff for 24-hour coverage based on rotation, hours worked and workload distribution.
  
• Continuous identification of service gaps and implementation of corrective measures.
  
• Observe confidentiality of client information and compliance with the Data Protection Act.
  
• Handle any other official tasks assigned by the line manager.
  

Knowledge Management

• Improve technical knowledge through self-learning or training including mandatory Continuous Professional Education requirements.
  
• Share knowledge with colleagues and peers in the business.
  
• Develop and enhance learning through seeking coaching, training and continual feedback
  

Reporting

• Sending daily admissions reports to clients; Brokers/Agents/ company Human resource managers.
  
• Prepare and compile section reports on daily, weekly and monthly basis and forwards to the management.
  

Relationship management

• Develop and maintain relationships with colleagues and clients; Brokers/Agents/ company Human resource managers.
  

Education, Experience Required and Competencies:

• Technical Skills: Proficiency in CRM software, Microsoft Office Suite
  
• Education: Bachelor’s Degree/Diploma in Nursing (KRCHN)/ Clinical Medicine/ Health Management or in a related field with up-to-date license.
  
• Experience: Minimum 2 years of clinical experience and 3 years case management experience
  
• Soft Skills: Excellent communication skills, empathy, negotiations, collaboration, problem-solving abilities, adaptability and a customer-centric approach.
  
• Industry Knowledge: Understanding of insurance policies, regulations, compliance and standards.
  

• Licensed by relevant statutory regulator in his/her respective medical field.