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Medical Aid Consultant

2 months ago

Durban, KwaZulu-Natal, South Africa Cirrusfin Full time
Job Summary

Cirrusfin is seeking a highly skilled and experienced Medical Aid Consultant to join our team. As a key member of our organization, you will be responsible for providing exceptional customer service to consultants, employers, and members, while also consulting on advice and factual information to clients via various channels.

Key Responsibilities
  • Customer Service
    • Provide professional and excellent quality of service to clients, ensuring a positive experience and retention.
    • Ensure Cirrusfin standards are maintained at all times.
  • Financial Management
    • Manage costs within your control, including telephone and printing expenses.
  • Clients
    • Build relationships with clients and medical schemes, and maintain knowledge of client details.
    • Act as the interface between member/client and medical scheme, ensuring open communication channels.
    • Provide factual information or advice on medical schemes, relevant legislation, and individual scheme protocols.
    • Problem-solving, including claims, chronic, amendments, and ensuring penalties are not incorrectly applied.
    • Liaise with medical aid and external parties as necessary, maintaining accurate and detailed communication and correspondence.
    • Exercise perseverance, patience, and good listening skills when interacting with clients, particularly in difficult situations.
    • Act on behalf of Cirrusfin in an ethical manner, ensuring honesty, integrity, and transparency.
    • Remain client-focused, results-oriented, and solution-focused, following through on set turnaround times.
  • Compliance to Internal Processes
    • Distribute queries daily to maintain service levels and turnaround times as per the service unit manual.
    • Ensure correct procedures and protocols are followed when submitting applications to medical schemes.
    • Establish and adhere to SLA within the team, as well as ensuring medical aid turnaround times are correct as per their service agreement.
    • Pay attention to detail, checking forms for completeness before routing to medical schemes.
    • Monitor the status of membership applications and amendments, following up until membership numbers/packs are received and distributed timeously.
    • Note all interactions and queries on the admin tracker.
    • Follow up on queries and resolve escalated problems in adherence to agreed turnaround times.
    • Ensure all written and verbal communication with clients is of a high standard, requesting information or advising on query outcomes efficiently and expeditiously.
    • Escalate problematic queries to consultant or manager when required.
    • Provide feedback to consultants and clients where applicable on queries or applications.
    • Issue FNA's timeously as per consultant manual and save on CRM.
    • Perform general administration, filing, and updating of CRM and admin tracker on a daily basis.
    • Issue standard documents, such as minutes of internal meetings and reports, to Manager and Service Unit promptly after meetings.
    • Provide prompt, professional, friendly, and helpful service at all times when dealing with clients and medical aid administrators, as well as internal staff.
    • Manage workflow by checking daily statistics to ensure equal distribution of workload and pulling reports to see that people are up to date with checking queries.
  • Project Management
    • Contribute to business development, projects, and initiatives.
  • People
    • Attend required internal and external forums and training courses.
  • Self-Development
    • Attend and set up frequent training sessions on products.
    • Accreditation is necessary in various medical schemes products, and it is essential to keep abreast of all relevant legislative and medical scheme issues.
    • Ensure Minimum FAIS credits are achieved within 1 year.
    • Exercise good self-management skills, including planning, prioritizing, and time management, as well as self-discipline.
    Requirements
    • Formal Qualifications
      • Matric
      • FAIS accredited (120)
      • RE1
    • Required Experience
      • At least 3 years of experience in the Healthcare Industry.
      • Healthcare Industry Knowledge.
    Core Competencies
    • Analytical Thinking & Attention to Detail.
    • Assertiveness (includes willingness to challenge & confront).
    • Excellence / Quality Orientation.
    • Rule orientation.
    • Results & Solution Focused (Passion, Drive, Energy & Follow-through) — including Action orientation.
    • Customer Service Orientation (internal and/or external clients / customers).
    • Relationship Building, Listening, Interpersonal Sensitivity.
    • Teamwork.
    TCF
    • Fulfil his/her duties in such a manner that the relevant TCF outcomes are delivered.
    • Constructively speaks up about any TCF shortcoming in any part of the business.
    • Quickly owns up to any mistakes or oversights he/she may be party to that may have negative TCF consequences.