The Care Officer – Call Centre is responsible for providing efficient and effective customer service to all GA Insurance Limited’s internal and external customers with the utmost level of consistency and quality.
Duties and Responsibilities
- Customer Support: Attend to client’s general queries i.e., answering calls from all customers regarding membership eligibility, claim status, benefit information, and claim payments and/or denials.
- Information Dissemination: Inform clients through calls by explaining procedures; answering questions; providing needed information.
- Pre-Authorizations: Ensure medical pre-authorizations/undertakings/ admissions / discharges /declines are issued in compliance with the policy provisions and as per the authority limits.
- Issue Resolution: Ensure that issues escalated, either through emails or calls, are resolved within stipulated timelines to ensure customer satisfaction and loyalty.
- Admissions Liaison: Liaise with doctors, brokers and clients via phone or emails for patient admissions.
- Benefit Optimization: Advise members on how best to utilise their benefits by recommending cheaper facilities and cheaper options e.g., maternity packages, chronic management facilities.
- Claims Logging: Log claims on the system on a timely basis.
- Turnaround Monitoring: Monitor the turnaround time on email response by logging in the time emails are received on the care team email address.
- Underwriting Liaison: Liaising with our underwriters for scheme membership / benefit / members / dependants missing details in the system and scope of cover.
- Escalations: Proper handing over of admissions and discharges above the authorized limit to the care nurse/ care senior officer.
Complaints Management and Audit Compliance
- Observe guided information to clients and relevant authorized parties are done in compliance with the Data Protection Act.
- Receive customer complaints or queries and document the same.
- Follow up on the complaints and ensure they are resolved within set service level agreements.
- Communicate feedback to clients.
- Participate in the process of identifying service gaps and give feedback on necessary corrective measures.
- Ensure that all issues are assigned to relevant parties and closed.
- Ensure follow-through of the set-out policies and procedures.
Academic and Professional Qualifications
- Bachelor’s Degree/Diploma in Nursing (KRCHN), Clinical Medicine & Surgery, Health Management or in a related field.
- Possession of Health System Management qualifications would be an added advantage.
- Kenya Registered Nurse/Kenya Registered Community Health Nurse.
- Additional training in customer service is an added advantage.
Experience
- At least 2 years of experience in a similar role and industry.
Technical Competencies
- Proficiency in MS Package.
- Conversant with medical terminology to explain benefits and claims clearly.
- Knowledge of insurance industry and concepts.
- Knowledge of insurance regulatory requirements.
- Working knowledge of customer and relationship management.
- Demonstrated experience in customer management and query resolution within care management.
Behavioural Competencies
- Demonstrated empathy and understanding in handling client concerns.
- Actively listening to accurately identify and address customer needs.
- Ability to multitask interactions and tasks efficiently.
- Strong customer service.
- Strong analytical and problem-solving skills.
- Results driven and action oriented.
- Collaborative team player.
- Strong attention to detail.
- Agile mindset with demonstrated ability to manage tasks with competing deadlines.
- High degree of emotional intelligence, integrity, trust and dependability.
- Ability to work independently as well as part of a team.
How to Apply
Interested and qualified? Go to GA Insurance on www.gainsuranceltd.com to apply.
