Medical Call Center Representative

2 weeks ago

Pretoria, South Africa care force Full time

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.

**Job Type**: Permanent

**Salary**: R10,000.00 - R20,000.00 per month

**Experience**:

- call centre: 4 years (required)
- Medical aid or medical insurance: 4 years (required)

Ability to Commute:

- Pretoria, Gauteng (required)

Ability to Relocate:

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

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