ROLE PURPOSE

 

To manage and deliver client support services within a small regional office environment by consulting with members, brokers and healthcare professionals, both face-to-face and virtually. The role resolves walk-in, referred, and electronic enquiries, ensures efficient office operations, and delivers outstanding customer service within a self-administered medical scheme environment.

 

Key Responsibilities


Functional Management


  • Attend to and resolve all client queries, whether walk-in, referred, email and virtual queries professional manner and escalate, escalating when necessary.
  • Investigate, reconcile and provide feedback on claims and stakeholder queries in line with SOPs and quality standards.
  • Manage and ensure smooth daily operations of the regional office
  • Prioritise and manage all office and client-related tasks independently.
  • Correctly identify and escalate unresolved queries within required timelines ensuring accountability and resolution tracking.
  • Investigate the various stakeholder queries, reconcile claims and provide comprehensive feedback as per the Standard Operating Procedures (SOP’s) and quality standards and/or escalate queries to the relevant stakeholder when required.
  • Provide high-quality service to members, brokers and healthcare providers, including recording feedback and complaints.
  • Assist with membership applications, including verification of documents.
  • Provide guidance on terminations, amendments and product-related enquiries.
  • Assist with finance and credit control queries, including arrears, suspensions, payments and reconciliations.
  • Assist with prescribed minimum benefit (PMB) queries and escalate when necessary.
  • Support new business with events and face-to-face engagements.
  • Capture claims where appropriate and refer complex cases.
  • Print membership cards upon request.
  • Maintain accurate records, manage office credit card reconciliations and support overall office operations.

Risk & Compliance

  • Follow fraud control measures, governance practices and risk-prevention principles.
  • Support internal, external and ISO audit requirements with accurate documentation.
  • Maintain risk management standards in line with ISO9001:2015.
  • Enforce Service Level Agreements to minimise business risk and support continuity.
  • Review SOPs with leaders to support business optimisation.
  • Adhere to all relevant laws, policies and Standard Operating Procedures.

Stakeholder Management

  • Build and maintain strong internal and external stakeholder relationships.
  • Provide support to business units to help achieve organisational objectives.


EXPERIENCE

QUALIFICATION

  • 5 Years Experience in Claims Assessment or Customer Service
  • 5 Years’ Experience working on Nexus systems
  • 5 Years in the Medical Aid industry
  • 5 Years experience in a Scheme/Administrator (not negotiable)
  • 2 Years experience in the role an advantage
  • NQF Level 5
  • Certificate in Contact Centre or Customer Service field or equivalent experience of 5 years

Knowledge

Skills

Attributes

  • Relevant legislation and regulatory frameworks
  • Risk Management practices and principles
  • Business acumen
  • Technical problem solving
  • Claims Assessing
  • Annexures and Scheme rules
  • Verbal and Written Communication
  • Decision-Making
  • Conflict management
  • Computer Literacy
  • Resilience
  • Detail Orientation
  • Innovative Thinking
  • Customer Centric
  • Results Focused
  • Quality Focused
  • Compliance Driven
  • Analytical Thinking
  • Problem Solving
  • Assertiveness
  • Confidentiality
  • Active Listening
  • Reading Comprehension

 

 

 
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