Clinical Call Centre Agent - Johannesburg, South Africa - Palesa Mbali Group

Description

Position:

Clinical Call Centre Agent

Position Purpose:

To provide professional customer service to Business unit members and brokers by ensuring that all call centre queries are handled to set performance standards at all times and ensuring prompt resolution of clinical queries within the Non-Clinical Authorisations queue.

Experience:

2 - 3 years clinical call centre experience in the medical aid industry

Qualifications:

A formal nursing qualification and registration/enrolment with SANC or a formal healthcare professional qualification (Registered Nurse).

Generic Objectives:

Specific deliverables:
Operating Model:
-Authorize hospital authorization requests by applying coding principles, scheme rules and benefits, and managed care policies and processes
-Authorize data on the system
-Correctly escalate complex clinical calls
Stakeholder Management:
-Educate and assist members by providing relevant clinical information to access the correct clinical benefits
-Consult member's health care professional to make informed clinical decisions and manage financial risk