Clinical Call Centre Agent at Kaelo Engage

Job Description

•        Log into the clinical Call centre daily on time
•        Interview members and Drs upon calling
•        Educate members on benefits such as Member Management Assistance Programme
•        Educate  member on the difference between GP consultation  and Virtual consultation benefits
•        Advise members on the effects of further management and refer to correct specialist
•        Refer member for  nurse consultation at a contracted pharmacy for minor ailments such as temperature, fever etc
•        Load valid Dr’s consultation events on valid request
•        Activate extra benefits for deserving members such as more than the required benefit 
•        Understand the benefit of different medical Insurance and Medical Aid differently
•        Access different systems to verify membership and plan type
•        Load virtual consultation and allocate time with the Chief Medical Officer
•        Respond to clinical enquiries from general call centre
•        Understand claims benefits and be able to explain to member
•        Maintain Service Level agreements on call volume
•        Load specialist auth numbers from the Case managers email address.
•        Basic understanding of Chronic Disease List
•        Ability to refer members to the correct department
•        Be comfortable to discuss HIV as an extra condition on enquiry
•        Understand the access to benefits  on different plan and policy options

KEY OUTCOMES

• Maintain Service levels above 85%
• Be willing to assist the Patient managers   with in-coming calls .
• Ability to maintain confidentiality as dealing with client clinical information
• Continuous support of members in need of help and
• Increase member satisfaction and understanding of benefits
• Ability to work well under pressure
• Be a team player 
• Reliable, dedicated and professional

Qualifications
SPECIAL REQUIREMENTS

• Experience in the medical aid Industry
• Confidence t deal with DR’s and members

PERSON DETAILS : WORK EXPERIENCE

REQUIRED

• Knowledge of the medical terminology
• Work in the medical aid industry
• Call centre experience will be an advantage

PREFERRED

EDUCATION : QUALIFICATIONS : ACCREDITATIONS WITH PROFESSIONAL BODY

REQUIRED

•        An enrolled nurse with an enrolled Certificate /or a Registered Nurse 
•        Registration with the SANC
•        Knowledge and experience of the medical industry
•        Ability to speak more than 1 African language will be an advantage
•        Basic understanding of the ICD 10 codes
•        Ability to show empathy  

PREFERRED

TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

• Attention to detail
• Computer literate
• Microsoft Access
• Clinical discretion

PREFERRED

Computer literacy.

Additional Information

•      Accountability
•      Action orientated
•      Communication
•      Business writing skills
•      Manages complexity
•      Problem solving skills
•      Encourages engagement
•      Planning and organisation
•      Resilient and adaptive
•      Systems thinking and connecting ability
•      Purpose driven
•      Significance and values orientated