Job Summary
To provide efficient and effective customer service to customers with utmost level of consistency and quality, ensure customer excellence and facilitate access to quality, safe, effective and cost-efficient care for insured clients. Respond to customer enquiries and address issues regarding products or services at the 24-hour contact centre.
Job Description
- Immediate management of inbound and outbound calls in line with contact center call guidelines/etiquette and provide solutions to customers in a professional way within the stipulated TATs.
- Guide the insured Members about their benefits management, the appropriate service providers and other related member benefit matters.
- Problem-Solving and Decision-Making: addressing complex customer issues and providing accurate information to ensure customer satisfaction.
- Technical or Customer-Facing Responsibilities: Handling technical aspects of customer interactions, utilizing CRM system and ensuring a seamless customer experience.
- Attend to client’s enquiries i.e., answering calls, responding to emails from customers, regarding membership eligibility, coverage, approval status, benefit information and case approvals and/or denials
- Ensure medical pre-authorizations/undertakings/ approvals /declines are issued in compliance with the policy provisions, authority limits and TATs
- Receive customer complaints or queries and document the same.
- Follow through and resolve escalated customers and provider queries and complaints in time and advise them on outcome and the details of the medical product.
- Escalate unresolved cases and follow through for their resolution and ensure customer satisfaction.
- Perform outbound calls and follow up post hospitalization clients for service feedback and enrollment to the chronic disease management program CDMP.
- Advise members on how best to utilize their benefits by recommending cost effective facilities and cheaper options e.g., maternity packages, chronic management.
- Negotiate rates and ensure recoveries from third parties like Social Health Authority are affected.
- Scheduling the call center staff for 24-hour coverage based on rotation, hours worked and workload distribution.
- Continuous identification of service gaps and implementation of corrective measures.
- Observe confidentiality of client information and compliance with the Data Protection Act.
- Handle any other official tasks assigned by the line manager.
Knowledge Management
- Improve technical knowledge through self-learning or training including mandatory Continuous Professional Education requirements.
- Share knowledge with colleagues and peers in the business.
- Develop and enhance learning through seeking coaching, training and continual feedback
Reporting
- Sending daily admissions reports to clients; Brokers/Agents/ company Human resource managers.
- Prepare and compile section reports on daily, weekly and monthly basis and forwards to the management.
Relationship management
- Develop and maintain relationships with colleagues and clients; Brokers/Agents/ company Human resource managers.
Education, Experience Required and Competencies:
- Technical Skills: Proficiency in CRM software, Microsoft Office Suite
- Education: Bachelor’s Degree/Diploma in Nursing KRCHN/ Clinical Medicine/ Health Management or in a related field with up-to-date license.
- Experience: Minimum 2 years of clinical experience and 3 years case management experience
- Soft Skills: Excellent communication skills, empathy, negotiations, collaboration, problem-solving abilities, adaptability and a customer-centric approach.
- Industry Knowledge: Understanding of insurance policies, regulations, compliance and standards.
- Licensed by relevant statutory regulator in his/her respective medical field.
