Fixed Term - Contact Centre Clinical Executive

Key Tasks and Responsibilities

• Answer all incoming calls professionally, providing support for a wide range of enquiries.
• Respond to all email enquiries and approval requests to the assigned email addresses within agreed turnaround time.
• Manage evacuation and ambulance requests efficiently and promptly.
• Collaborate with providers and the Case Management team to manage admissions and discharges of Old Mutual members.
• Process pre-authorization requests for outpatient, dental, and optical services, ensuring quality and cost-efficiency.
• Mitigate risk by ensuring proper adjudication of pre-authorizations / claims in line with Old Mutual policies (e.g., enforcing waiting periods).
• Collaborate with providers and clients to identify cost-effective options and implement key initiatives that maximize value for members.
• Offer detailed and accurate information about Old Mutual’s provider network, policy terms, and available services.
• Resolve smart access issues raised at the point of service in conjunction with Smart applications.
• Maintain accurate and timely documentation of all interactions and services provided.
• Escalate or liaise with claims/care teams on any issues requiring further consultation.
• Participate in all required training sessions and departmental meetings.
• Perform general contact centre duties, including customer surveys, social media, and email management.
• Perform all other tasks as assigned by the Contact Center Manager or Quality Assurance Supervisor.

Skills and Competencies

• Communication Skills: Clear, concise, and courteous verbal and written communication.
• Problem Solving: Able to assess issues quickly and take appropriate action.
• Attention to Detail: Ensures accuracy in processing requests and documenting interactions.
• Teamwork and Collaboration: Works effectively with internal teams and external service providers.
• Customer Service Excellence: Demonstrates professionalism, empathy, and efficiency.
• Technical Skills: Proficiency in contact centre systems (telephony, CRM, email tools).

Knowledge and Experience

• Strong understanding of clinical guidelines, healthcare processes, and insurance policy application.
• Knowledge and experience in customer experience delivery.

Qualifications

• Bachelor’s Degree or Diploma in Clinical Medicine, Nursing, or a related healthcare field.
• Diploma or certification in Insurance Proficiency is an added advantage.

How to Apply

Interested and qualified candidates should apply online through the Old Mutual Workday portal: Apply Here