Job Opportunities at Kaelo

Job Description

The Kaelo Health Core Servicing Consultant is responsible for responding to queries, managing complaints, troubleshooting service problems and providing general information regarding our products. Manage our customer experience with excellence and accuracy.

KEY OUTCOMES (not limited to) Level 4 and 5 process elements

• Manage incoming queries and outbound responses with:
• Members
• Service Providers 
• Intermediaries 
• Provide product specific information 
• Assess and determine when there is an operational query
• Identify and escalate priority issues 
• Manage and resolve customer complaints
• Maintain client information  
• Complete administrative tasks 

Qualifications

SPECIAL REQUIREMENTS

PERSON DETAILS: WORK EXPERIENCE

• 1 – 3 years call centre experience preferably with short-term insurance and health industry knowledge and experience

EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY

REQUIRED

• Matric Certificate 

TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

• Knowledge of customer service practices and principles
• Excellent listening, verbal and written communication skills 
• Ability to handle stressful situations appropriately 
• Proficient in Microsoft and Excel 
• Call centre systems and multi-tasking

PREFERRED

Additional Information

• Accountability
• Action orientated
• Collaborative
• Communication
• Business writing skills
• Manage complexity
• Problem solving skills
• Decision thinking
• Encourages engagement
• Resilient and adaptive
• Resourceful
• Demonstrates self-awareness
• Purpose driven
• Significance and values orientated

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Job Description

The purpose of this role is to support and empower members and their dependents reaching out for specialised coaching services.

KEY OUTCOMES

• Assessment of coaching need
• Provide coaching support in terms of life coaching, leadership coaching, parent coaching and career guidance.

Qualifications

REQUIRED

• Minimum of 3 years coaching experience

PREFERRED

• Experience in the EAP field or knowledge of the field is preferable

EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY

• NLP Life Coaching or equivalent qualification

TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

• Proficient in relevant computer applications
• Required language proficiency
• Knowledge of customer service principles and practices
• Knowledge of call centre telephony and technology
• Good data entry and typing skills
• Knowledge of administration skills and processes

PREFERRED

• Additional Information
• Accountability
• Action orientated
• Strategic thinking and mind-set
• Collaborative
• Communication
• Business writing skills
• Manages complexity
• Problem-solving skills
• Creative thinking
• Decision
• Efficient and Effective mind-set
• Growth and development mindset
• Negotiating skills
• Planning and organisation
• Resilient and adaptive
• Resourceful
• Demonstrates self-awareness
• Self-development
• Systems thinking and connecting ability
• Purpose-driven
• Significance and values orientated

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Job Description

• The role is responsible for the authorising casualty cases with benefits telephonically or per email.
• Load all hospital related cases for  casualty treatment and admission into hospital.
• Communicate with the clients on the benefit availability and limitation.
• Review the correct level of care for admitted clients.
• Negotiate with Health Care providers for clinical information.
• Discharge planning for admitted patients. 
• This position reports to the Health Operations Manager. This position’s functions are supervised by the clinical service manager.

Key Outcomes 

Responsibilities include:

• Ensuring service level agreements are met.
• Answering calls routed through for casualty or hospital treatment and admission. 
• Identify exclusions from the onset of request for treatment.
• Ensure that correct benefit is utilised by member.
• Correct level of care is allocated to the correct facility.
• Latest medical guidelines are used within the available benefit.
• Reporting on cases actioned per month including savings.
• Report any clinical escalations/concerns to the clinical Review team.
• Act as a patient advocate  
• Maintain all the confidentiality in clinical conditions shared with her/him.
• Review latest appliances used in hospital against the current treatment guidelines.
• Educate patients on benefit and limitations on their insurance option.
• Developing referral and treatment protocols for new or updated conditions identified.
• Discussing diagnosis with doctors, specialists and other health care providers,
• Conducting assessments of patient needs, such as mental health issues or substance abuse problems and refer to EAP where applicable.
• Providing information about treatment options, side effects, and possible complications of medications or procedures
• Assisting with monthly reporting on statistics
• Utilize all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, and manage patients admitted.
• Thoroughly complete documentation utilizing the appropriate computer software in compliance with the approved policies and procedures.
• Maintain current nursing skills and knowledge base by attendance at workshops and seminars, completion of mandatory continuing education, reading of professional journals, publications, and participation in professional organizations.

Qualifications

Required

• Registered Nurse
• Degree /Diploma in Nursing
• ICU/Operation theatre trained, or experience is an advantage.
• 2 years hospital Case Management experience would be beneficial.
• Medical Aid or Insurance industry experience will be an advantage.
• Sound knowledge of ICD and CPT coding and DRG’s

Preferred

• Professional Nurse with SANC registration
• Prefer minimum of three years recent clinical experience in health, critical care and/or emergency room.
• Familiarity/experience with patient interactions on the telephone
• Strong communication and interpersonal skills

Technical Skills or Knowledge 

• Attention to detail.
• Health risk assessment knowledge
• Computer Literacy