Medical Contact Centre Officer – (2400002A)
Job Purpose and Key responsibilities
Job Purpose:
To ensure the provision of consistently high quality Customer experience through quality service interactions by the Contact Centre team in compliance with overall Service strategy and standards while ensuring full accessibility and availability of the Customer Experience Centre to Customers. This role also plays a critical role in support of retention strategies for the Health business.
Key responsibilities:
- Drive progress towards the goal to reduce operational costs and increase total number of customers via retention by answering calls in a professional and informative manner.
- Handling customer queries, complaints, instructions received through call and email communication 24/7.
- Interact with clients, intermediaries, and service providers to ensure that the care is given within policy guidelines.
- Adherence to admission and discharge protocol i.e. claim reserve, initial authorised cost, cover benefits, duration and analyse proposed risks and make decisions to accept or reject
- Respond to queries from clients, intermediaries, and service providers through answering telephone calls, interviewing clients, and verifying information as well as liaise with underwriters on the scope of cover for the various schemes benefits. Ensure to comply to the company credit policy.
- Prepare periodic care reports for management on medical matters/ issues;
- Maintain and improve quality results by adhering to standards and Customer Experience guidelines,recommending improved procedures with a QA score target 90%,NPS +30, CSAT 90%.Customer Effort 90%.
- Ensure clients outpatient approvals are issued via email as per SLA .
- Maintains communication equipment by logging in 90% of interactions through CRM for traceability / visibility;
- Ensure risk survey recommendations are communicated in time and follow up implementation
- Build and manage relationships with brokers, agents, and other intermediaries.
- Monitor market trends and competitor activities to stay informed about industry developments and stay updated on changes in laws and regulations that may affect client retention efforts.
- Work closely with sales, marketing, actuarial, claims and underwriting to align retention strategies with business goals.
- Proactively manage all queries on the policy renewal process to ensure timely renewals and minimize lapses in coverage.
- Develop and implement strategies to improve client retention rates.
- Delegated Authority: As per the approved Delegated Authority Matrix.
- Prepare periodic reports for management on medical claims.
- Ensure claims are processed within the stipulated time.
- Perform any other duties as may be assigned from time to time.
Knowledge, experience and qualifications required
Knowledge, experience and qualifications required:
- Diploma/Degree in Nursing/ Diploma in clinical medicine/ Diploma in Pharmacy/ Business degree – Insurance Option.
- Progress in Professional qualification in Insurance (ACII, FLMI or IIK).
- 2-5 years’ experience in medical.
- Proven experience in managing and nurturing client relationships.
- Track record of achieving client satisfaction and retention targets.
Technical/ Functional competencies:
- Knowledge of insurance regulatory requirements.
- Knowledge of insurance products.
- Sales and marketing management skills.