Job Ref. No: JHIL104
Role Purpose
The job holder will be
responsible for attending to intermediary, customer, and providers queries by
determining their requirements, answering these inquiries, resolving problems,
and fulfilling customer’s requests. The holder will be required to ensure
excellence in all customer interactions and offer memorable experiences.
Main Responsibilities
Operational
Delivery of exceptional
customer experience in all interactions on call and email by maintaining the
highest level of professionalism.
Manage urgent or critical
cases promptly, coordinating immediate interventions and connecting with
emergency services as needed.
Issuing preauthorization
approvals for all outpatient, dental, optical, and inpatient cases.
Keep a clear complaint
tracker and ensure timely resolution of all complaints and escalations.
Respond to
potential/existing customer and intermediaries’ inquiries by providing and/or
clarifying the desired information.
Identify appropriate
specialists, services, or community resources that can contribute to the
member’s overall health and well-being.
Resolves complaints by
clarifying issues and exploring answers and alternative solutions, implementing
solutions, and escalating unresolved complaints.
Evaluate the healthcare
needs, history, and current condition of members to develop a clear
understanding of their healthcare requirements.
Ensure strict process
compliance in line with the business lines objective.
Selling additional
products by recognizing opportunities to cross-sell or up-sell new benefits.
Maintain and improve
quality results by adhering to standards and guidelines, and recommending
improved procedures.
Generate reports on the
various engagements and feedback collected. Contribute to quality improvement
initiatives by providing insights and feedback to enhance care processes and
outcomes.
Collaborate with dental
professionals, specialists, and providers to coordinate and facilitate
comprehensive dental care for insured members.
Review all treatment
plans, ensuring they align with medical guidelines, member needs, and insurance
coverage.
Engage with insured
members to explain treatment options, address concerns, and support them
throughout their healthcare journey.
Identify appropriate
specialists, services, or community resources that can contribute to the
member’s overall health and well-being.
Key Competencies
Empathy skills
Listening skills
Verbal communication
Adaptability
Attention to detail.
Good Interpersonal
relationships
Ability to multi-task
Proficiency in optical
terminology and eyecare processes.
Proficiency in dental data
analysis and interpretation.
Proficiency in medical
terminology.
Qualifications
Graduate from a recognized
university
Medical professionals have
an added advantage.
Proficient in the use of
Microsoft Office suite and packages
Relevant Experience
Minimum of 1 year
experience in a Call Centre environment.
How To Apply
If you are qualified and
seeking an exciting new challenge, please apply via Recruitment@jubileekenya.com quoting the Job
Reference Number and Position by 21st January 2024 Only shortlisted
candidates will be contacted.
