Customer Care jobs, Medical jobs, Healthcare jobs,
Medical Officer
Purpose for the Job
- To support the clinical functions in the division by reviewing all preauthorization requests with the relevant medical teams, engaging with Medical Officers within medical facilities for any disputed cases, and supervising Quality Assurance of the medical functions (Pre-authorization and Claims) with a view to enhanced Customer Experience.
Duties and Responsiblities
Operational Roles and Responsibilities
- To adhere to the set protocols and matrix of management of preauthorization requests.
- Ensure next level management of disputed medical cases – i.e. communication to the satisfaction of the member.
- Supervise the Quality Assurance team that provides oversight over the Preauthorization and Claims functions.
- Thought Leadership through insightful articles.
- Preparation of adequate packages and price lists for service provider contracts.
- Continuous training and upskilling of the pre-authorization and claims personnel within the division.
- Any other duties as may be assigned by the supervisor.
Key Result Areas
The accountability areas are as follows:
- Positive Customer Experience
- Enhanced Quality of Service
- Policy guidance
- Care options information
- Discount negotiations/Cost Control
Key Competencies
- Benefit coordination
- Conflict resolution
Knowledge And Skills Required
- At least 5 years’ experience in relevant field
- Communication skills
- Detail oriented
- Interpersonal skills
- Negotiations skills
- Leadership skills
Professional and Academic Qualifications
- Bachelor of Medicine and Bachelor of Surgery
- A Masters degree in a medical field
- Registration with the KMDPB
Customer Experience Champion
Purpose for the Job
- To review all inbound and outbound calls from the Call Centre with the aim of picking out relevant issues raised through the call centre, providing resolution mechanisms, identifying call trends, reviewing call data, and sharing management reports on the same.
Duties and Responsiblities
- Monitoring and evaluating call centre agent performance and proposing corrective action where necessary.
- Answering agent questions regarding best practice or difficult calls.
- Identifying operational issues and suggesting possible improvements.
- Preparing reports and analysing data to assist management determine call centre performance.
- Working with Call Centre supervisors and management team members to support agents and maximize customer satisfaction.
- Listening in to Agent calls and making recommendations on areas of improvement.
- Making outbound calls to members on any disputed cases and reasons for this.
- Any other duty as may be assigned by the supervisor.
Key Competencies
- Experience in manning a contact centre.
- Ability to remain calm and courteous under pressure and navigate tense situations, especially during busy hours.
- Ability to coach, train, and motivate employees and evaluate their performance.
- Strong understanding of company products, policies, and services.
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Knowledge And Skills Required
- Proficiency with technology, especially computers, software applications, and phone systems.
- Exceptional verbal and written communication skills.
- Excellent problem solving, leadership, and customer service skills.
- Analytical, efficient, and thorough.
Professional and Academic Qualifications
- Degree in related field
- 5 years Call centre experience with 2 in a supervisory role
- Diploma or Degree in Clinical Medicine or Nursing will be an added advantage.