Jobs at Kaelo

Job Description

• The Kaelo Health Specialised Servicing Consultant is responsible for responding to complex queries, managing complaints, troubleshooting service problems and providing general information regarding our products. Manage our customer and provider experience with excellence and accuracy. As a Specialised Consultant you will be expected to perform using a variety of channels, including telephonic and correspondence as well be skilled on all Kaelo products. Management of the provider relationship from contracting , service level agreements, administration, and reporting.

KEY OUTCOMES

• Manage networks
• Rango appointment management and reporting on the Halo network
• Management of authorisations

Grow and maintain network providers

• Maintain contact information and communicate and store according to the business rules and requirements
• Maintain on-boarding and off-boarding of health providers
• Maintain client information  

Resolve network related escalations

• Ensure maintenance of SLA’s and correct escalation protocols are adhered too

Source and contact health providers

• Report on networks and appointments
• Weekly and monthly reporting , but not limited to this frequency
• Negotiate annual tariffs

Manage incoming queries and outbound responses with:

• Members
• Service Providers
• Intermediaries
• Health Providers
• RAF (Road accident fund)requests manage relationship with third party stakeholder
• Manage omni-channel responses (including telephonic and correspondence) 
• Provide product specific information across full product suite
• Assess and determine when there is an operational query and or complaint
• Identify and escalate priority issues

Manage and resolve customer and health provider complaints

• Complete administrative tasks 
• Continuous improvement and quality assurance
• Monitor and manage trends
• Conduct root cause analyses

SPECIAL REQUIREMENTS

• Ability to maintain confidentiality, problem solve, negotiate and communicate, attention to detail. Ability to handle stressful situations appropriately 

Qualifications
PERSON DETAILS: WORK EXPERIENCE
REQUIRED

• At least 3 years’ experience in the Medical Scheme or Healthcare Industry in a data administration role 
• Knowledge of customer service practices and principles
• Excellent listening, verbal and written communication skills 

PREFERRED

• Proven work experience in the Healthcare administration or managed care environment

EDUCATION: QUALIFICATIONS: ACCREDITATIONS WITH PROFESSIONAL BODY
REQUIRED

• Grade 12 or equivalent NQF 4 certificate

PREFERRED

TECHNICAL SKILLS OR KNOWLEDGE
REQUIRED

• Computer Literacy – Microsoft Excel, Word and PowerPoint
• Strong phone, email (written) and inter-person communication skills
• Call centre systems and multi-tasking

PREFERRED

• Knowledge of Medical Scheme Industry

Additional Information

•       Accountability
•       Action orientated
•       Collaborative
•       Communication skills
•       Simple writing skills
•       Problem solving skills
•       Encourages engagement
•       Manages complexity
•       Resilient and adaptive
•       Purpose driven
•       Significance and values orientated

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Job Description

• The Kaelo Health Call Centre Team Leader will support Servicing Consultants with coaching, training and quality management.  
• Call centre servicing and escalation management. Prime Cure, Client services.

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

Reporting and Managing Key Team Deliverables

• ·       Monitoring of the daily dashboard to ensure adherence to SLA
• ·       Monitoring the teams accurate and efficient processing of claims

Contribute towards continuous improvement and innovation at process and procedure level

•        To ensure that all queries are attended to accurately and within the agreed turnaround time
•        Monitoring of daily performance statistics and workforce management
•        Daily Service Centre focus and work allocation
•        Assist clients with escalated queries and provide suitable query resolution
•        Accurate completion of people management tasks on a daily basis
•        Ongoing feedback to clients

People and Team Management

•        People and team management
•        Ensuring participative leadership and strong communication within the team
•        Collaboration with all business areas
•        Coaching and peer to peer learning

Knowledge and Quality Management

•        Developing of all employees and ensuring smooth onboarding for new employees.
•        Review, maintenance and improvement of all processes and document management

Quality assurance and trending

• ·       Contribute toward risk management

SPECIAL REQUIREMENTS

•        Communication skills
•        Analytical ability
•        Time management
•        Customer focus
•        Ability to adapt to an ever changing environment
•        Cope well under pressure

PERSON DETAILS: WORK EXPERIENCE

REQUIRED

• ·       2 Years’ Service centre experience
• ·       1 Year team management and leadership experience
• ·       Health claims experience

PREFERRED

•        Health Insurance industry
•        Membership and data capturing experience

Qualifications
REQUIRED

•        Grade 12 – Matric
•        Post matric general management qualification

RE 5

•        Accreditation would be advantageous (a minimum of 120 credits

PREFERRED

TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

• ·       Computer literate, including Microsoft Excel (Intermediate – Advanced)

PREFER­­­­­RED

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