Medical Call Centre Agent

2 weeks ago


Pretoria, Gauteng, South Africa Careforce Recruitment Full time
Our client, a managed care organisation based in Pretoria is looking for a Call Centre Agent.

This is an equal opportunity organisation with various businesses and/ or subsidiaries that service clients in the medical scheme and insurance industries.


Position:
Medical Call Centre Agent

Reporting to:
Operations Manager

Hours: 40 hours per week (Based on a shift roster, which includes Saturday)

Location:
Head Office, Pretoria

Purpose of the position:

Responsibilities and duties:

  • Membership Related Queries _
  • Adding or removing of dependants
  • Processing medical scheme membership medical card requests and ensuring that it will be delivered to the correct address.
  • Sending membership certificates when required.
  • Sending tax certificates to members during tax season.
  • Submitting all member requests for updates in personal information to membership.
  • Assisting providers by submitting their updated information to membership to be amended on the system.
  • Claim related Queries _
  • Assisting members/providers with queries regarding rejected claims, explaining the reasons for rejection and follow up measures to be taken for reprocessing of their claims.
  • Assisting members/providers with queries regarding short paid claims, explaining the reasons for any shortfall and follow up measures to be taken for reprocessing of their claims.
  • Submitting claims to the audit department as requested.
  • Authorisation, Hospital, and Risk Management _
  • Assisting members, providers, employer HR personnel, broker consultants with the process of obtaining an authorisation for secondary and tertiary healthcare services
  • Assisting members and providers with queries relating to a member's admissions
  • Assisting members/providers with challenges relating to TTO medicine following discharge from hospital.
  • Pharmaceutical Benefits and Disease Management _
  • Assisting members with all acute/chronic queries
  • Following up on the progress of the chronic condition registration
  • Following up on the delivery of the chronic medication and giving feedback to members as to when delivery can be expected
  • Assisting members/service providers who experience challenges at pharmacies for OTC medication.
  • Assisting members who paid cash for medication on how to claim for reimbursement.
  • Assisting members/service providers to complete the forms and advising on what supporting documents are required to register on Disease management programmes
  • Product & Benefit Related Queries _
  • Confirmation of benefits on all options to member's and providers
  • Educating members on their option and the scheme rules and exclusions
  • Promoting the product to potential clients
  • Continuous member education on all calls

Work Experience & Skills:
years call centre experience within a medical scheme or insurance environment

  • General Business acumen
  • Time management skills follow up must be able to establish procedures to monitor that, which has been promised and delivered
  • Proficient in the use of the Microsoft (MS) Office suite of products, specifically MS Outlook, MS
  • Excel and MS Word
  • Excellent interpersonal skills
  • Excellent telephone skills
  • Excellent listening skills
  • Excellent verbal and written communication skills
  • Problem solving skills

Academic & trade qualifications:

  • Essential qualifications: Matric
  • Desirable qualifications: Post matric studies/qualification will be an advantage.

On Offer:
Market related salary based on experience and qualifications.

Should you be interested in this position, and you meet the requirements, please send your

Experience:

Call Centre: 3 years (required)

Ability to Commute:

  • Gauteng, Gauteng (required)

Ability to Relocate:

  • Gauteng, Gauteng: Relocate before starting work (required)

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