Key responsibilities:

• Handling customer queries, complaints, instructions received through call and email communication.
  
• Interact with clients, intermediaries and service providers to ensure that the care is given within policy guidelines.
  
• Set the appropriate parameters for admission cases i.e. claim reserve, initial authorized cost, cover benefits and duration.
  
• Respond to queries from clients, intermediaries and service providers through answering telephone calls, interviewing clients and verifying information. Liaise with underwriters on scope of cover for the various schemes benefits.
  
• Ensure that medical scheme members are attended to round the clock.
  
• Prepare periodic care reports for management on medical matters/ issues.
  
• Maintains and improves quality results by adhering to standards and guidelines while recommending improved procedures with a QA score target.
  
• Ensure clients outpatient approvals are issued via email as per SLA.
  
• Facilitate admissions and discharges appropriately.
  
• Maintains communication equipment by logging in interactions through CRM for traceability / visibility.
  
• Maintain and monitor telephone budget allocation to ensure lines are diverting to E1 lines.
  
• Delegated Authority: As per the approved Delegated Authority Matrix.
  

Key Performance Measures:

As described in your Personal Scorecard.

• Degree/ Diploma in Nursing or related medical field.
  
• 3 - 5 years in a similar role.
  
• Knowledge of insurance regulatory requirements.
  
• Knowledge of Britam products and services.