3. KNOWLEDGE & EXPERIENCE

• Strong understanding of clinical guidelines, healthcare processes, and insurance policy application.
  

• Knowledge and experience in customer experience delivery.
  

4. QUALIFICATIONS

• Bachelor’s Degree or Diploma in Clinical Medicine, Nursing, or a related healthcare field.
  

• Diploma or certification in Insurance Proficiency is an added advantage.
  

• Answer all incoming calls professionally, providing support for a wide range of enquiries
  

• Respond to all email enquiries and approval requests to the assigned email addresses within agreed turnaround time
  

• Manage evacuation and ambulance requests efficiently and promptly
  

• Collaborate with providers and the Case Management team to manage admissions and discharges of Old Mutual members
  

• Process pre-authorization requests for outpatient, dental, and optical services, ensuring quality and cost-efficiency
  

• Mitigating risk-ensure proper adjudication of pre authorizations / claims in line with the Old Mutual policies, e.g. enforcing of waiting periods among other terms and conditions
  

• Collaborate with providers and clients to identify cost-effective options and implement key initiatives that maximize value for our members
  

• Offer detailed and accurate information about Old Mutual’s provider network, policy terms, and available services
  

• In conjunction with Smart applications resolve smart access issues raised at the point of service
  

• Maintain accurate and timely documentation of all interactions and services provided
  

• Escalate / liaise with claims/ care teams on any issues which require further consultation
  

• Participate in all required training sessions and departmental meetings.
  

• Perform general contact centre duties, including customer surveys, social media, and email management
  

• Performs all other tasks as assigned by the Contact Center Manager or the Quality Assurance Supervisor