Medical Call Centre Agent

6 months ago

Pretoria, 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 re-processing 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 re-processing 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:

- 3 - 5 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**:

- Customer service: 3 years (required)

Ability to Commute:

- Pretoria, Gauteng (required)

Ability to Relocate:

- Pretoria, Gauteng: Relocate before starting work (required)

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