Back Office Agents - Johannesburg, South Africa - Palesa Mbali Group

Palesa Mbali Group

Verified Company

Johannesburg, South Africa

1 week ago

Posted by:

Thabo Mthembu

beBee Recruiter

Description

To support the management team in the client's Management department and to attend to escalated queries. To ensure the prompt resolution of member queries regarding all medical aid claims, telephonically and in writing.

Key Activities

Defined legal, statutory and regulatory compliance is maintained at the required standards
Operational risk and governance structures, measures and frameworks are complied with and necessary action is taken to address issues, when necessary
Ensure that payments were processed at correct rate and against available benefits
Investigate all documentation, correct where required and link to member's records
Analyse and correct incorrect payments and identify reason for nonpayment. Apply
Quality Analysis checklist to processing of claims
Provide comprehensive and accurate feedback to clients
Identify system constraints and escalate accordingly
Assist in Call Centre/other areas when required
Ensure that quality control targets are met
Meet delivery objectives through working with other team members within and linked to the department / project
Resolve operational performance variations and problems and escalate unresolved issues to higher levels
Ensure delivery targets/objectives are met and operate in a supportive manner to achieve successful delivery
Ensure appropriate, active and informative relationships with customers and relevant stakeholders are successfully achieved
Address customer or stakeholder complaints in alignment with the policies and procedures and ensuring customer / stakeholder buyin

Skills

Problem solving and decision making skills
Business Writing Skills
Communication Skills
Computer Technology Skills
Task Management
Adobe Creative Suite
Data modelling and evaluation
Attention to Accuracy and Detail
Numerical Ability
Customer Focus

Experience and Qualifications

2 years' experience in the medical aid industry, Business writing skills in English is essential, Investigative, communication and interpersonal skills required, In depth working knowledge of the client's rules will be advantageous, Claims processing experience essential

Company Description - A formidable company that aims to deliver exceptional services.