Job Ref. No: JHIL191
Role
Purpose
The job
holder will be responsible for attending to intermediary, customer, and
providers queries by determining their requirements, answering to these
inquiries, resolving problems, and fulfilling customer’s requests. The holder
will be required to ensure excellence in all customer interaction and offer
memorable experiences.
Key Responsibilities
Operational
- Delivery exceptional customer experience in all
interactions on call and email by maintaining 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 with 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, 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
Skills and Competencies
- Demonstrated empathy and understanding in
handling client concerns.
- Actively listening to accurately identify and
address customer needs.
- Adaptable to changing systems, policies, and
client needs.
- Attention to detail in data entry, policy
interpretation, and documentation.
- Ability to multitask interactions and tasks
efficiently.
- Clear understanding of optical terminology and
eyecare benefit processes.
- Proficiency in interpreting dental records and
benefit structures accurately.
- Conversant with medical terminology to explain
benefits and claims clearly.
Academic & Professional
Qualifications
- Graduate from a recognized university
- Medical professionals have an added advantage.
- Proficient in the use of Microsoft Office suite
and packages.
Relevant
Experience
- A minimum of 1 years’ 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 19th September 2025 Only
shortlisted candidates will be contacted.
