With over 100 years of rich history and strongly positioned as a local bank with regional and international expertise, a career with our family offers the opportunity to be part of this exciting growth journey, to reset our future and shape our destiny as a proudly African group.
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Job Summary
To perform all the case management roles both at the contact centre and back office, which includes but not limited to:
Job Description
- Sensitise and Provide information to clients about their policy guidelines.
- Continuously advise clients about the most cost-effective service options to Clients/Brokers/Agents/ company Human resource managers.
- Facilitate for member sensitization and registration.
- Organize for hospital transfers and evacuations in reference to their policies.
- Calls managements in line with the international call centre standards.
- Organise and participate in Carrying out health forums for clients.
- Professional Handling of clients and service providers grievances within the stipulated time.
- Managing requests for services from providers, intermediaries, and clients, providing information on the FAK provider network, available benefits per scheme policy and services and other routine information
- Respond to all emails and give feedback within one 30 minutes of receiving them.
- Critically analyse and give accurate response to all pre-authorization within the defined TATs and in line with member policy benefits.
- The care manager to accurately to decode prescriptions and other bills to identify any anomalies.
- Negotiate with service providers for sustainable costs containment.
- Mitigate fraud cases through hospitals visitation of admitted patients in various hospitals, and vet all inpatient bills.
- Ensure the service access turnaround time is within the stipulated Service Level agreement, Discharges within 30 minutes, outpatient responses within 10 minutes.
- Sending daily admissions reports to clients; Brokers/Agents/ company Human resource managers.
- Offer first aid to any emergency cases within/around First Assurance Office.
- Response to all escalations from the contact centre, carrying out customer surveys, social media and email management.
- Performs all other tasks as assigned by the Line manager.
Education Qualifications & Experience
- Bachelor’s degree or Diploma in nursing or clinical Medicine and Surgery
- Minimum of 1 – 3 years’ experience in a similar role in the insurance industry.
Education
Further Education and Training Certificate (FETC): Business, Commerce and Management Studies (Required)
