Medical Call Centre Agent - Centurion, South Africa - H2R Africa

Description

MEDICAL CALL CENTRE AGENT WITH UNDERMENTIONED KNOWLEDGE.

Our client in the Medical field is looking for a Call Centre Agent who will also be responsible to administer incoming product support or attend to information enquiries from clients.

Handling of incoming calls, assisting with account enquiries, member requests and/ or other support issues. Attending to all email and WhatsApp requests from members, service providers and internal parties. Verifying the members information and ensuring confidentiality.


Adding or removing of dependants.
Emailing/faxing membership related forms to members or relevant employer groups HR department or allocated broker consultant. E.g. Cancellation forms, application forms, change of option form, changes in membership status form etc.
Processing medical scheme membership 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 system.


Claim Related Queries
Submitting all claims received from members and providers via fax or email to the claims department.

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 members 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 members 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.


Resources
Membership & Claims Department.
RX Health Pharmaceutical Department.
RX Health Hospital Management & Ambulatory Services.
RX Health Disease Management.
RX Health Active Disease Management.
Mediscor PBM.
Mediscor ChroniLine.
HR from Employer Groups.
Broker Consultants.


Skills
Active team player.
Knowledge retention.
Attention to detail.
Organized.
Flexibility.
Friendly.
Calm under pressure.
Effective communication skills (Verbal & Written).
Expediency.
Quality.