Service Recovery Specialist

2 weeks ago

Durban, KwaZulu-Natal, South Africa Health Solutions Full time

Introduction


Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value.

We build and maintain a culture of innovation, and create value through unique insights of how to achieve specific outcomes by using a defined set of Health capabilities.


Role Purpose


Resolution of high level and escalated queries and retention of current membership base including social media, hello Peter, Business escalation and complementary products.


Requirements:

  • Matric or Grade 1
  • Diploma will be an advantage
  • 35 year's industry experience
  • Business communications skills
  • Complementary product knowledge is essential
  • Social media knowledge is essential

Duties & Responsibilities

  • Handling high level unresolved queries/disputes arising from clients.
  • Ensure that the appropriate service recovery measures and plans are implemented to handle member escalations.
  • Liaising with the departments that do not meet the standards of service as laid down in Scheme service level agreements.
  • Ensuring that the recommended corrective measure to the defaulting departments does not take place
  • Identify areas where training is required to improve service levels.
  • Identify process and system shortfalls in order to improve efficiencies.
  • Reduce repeat calls and volumes into the business.
  • Building and maintaining relationships with coaches, service managers & heads of the various business units.
  • Compilation of service recovery and retentions reports.
  • Keeping a record of escalated queries, complaints and the corrective action taken to resolve problematic areas within the business.
  • Ensuring that member feedback on queries received via 30/30 and the business is finalised within 24 hours of receipt.
  • Ensuring 15 minute feedback on social media enquiries.
  • Reports as requested by the Scheme are accurately and timeously completed and included in the necessary documents.
  • All departments meet requirements as per service level agreement with Scheme.
  • Process improvements are tracked and there is evidence to show improvement.
  • Contribute to the growth of the business retention
  • Investigating hospital rejected claims identifying root cause and getting the claims reprocessed timeously and prevent a delay in hospital claims payments.

Competencies

  • Understands how the business operates, what the key issues and risks are that drives business success; and how they impact on the commercial viability of potential ventures and the profitability of the Group
  • Anticipates, meets and exceeds client's needs by creating long lasting relationships that support the client value proposition, supports their financial wellness and ensures client centricity.
  • Drive a sense of urgency, focus, accountability, agility and execution to deliver business results.
  • Actively leads change, does what is right for the business and drives continuous improvement through innovation.
  • Creates and maintains an open, positive working environment by generating commitment, building trust, a shared sense of purpose, empowerment in others and encouraging them to contribute to the best of their ability.
  • Prioritises the business interests of MMHand invests in the success of the group by aligning effort across divisions.
  • Persuades, convinces, influences and inspires others, both within MMHand externally to win support, loyalty and gain commitment to the purpose of MMH.
  • Manages self and relationships with others effectively, deals with ambiguity, uncertainty and pressure, and provides perspective in difficult situations.
  • Is sensitive to individual and cultural differences and demonstrates humility and an openness to engage people from diverse backgrounds and cultures to the mutual benefit of all parties concerned.
  • Takes responsibility for own development; and actively mentors, coaches and develops talent in others. Builds leadership bench strength for MMHby providing opportunities and experiences to develop skills, competencies and business knowledge.

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