Medical Aid Case Manager jobs

Job Specification

Member Service Unit Consultant

Ensuring and providing a professional and excellent quality of service to consultants, employers and members; as well as consulting advice/ factual information to clients telephonically, electronically and face to face. Customer service should always be of the highest standard to ensure that the clients have positive encounters with us and thus ensuring that the client is retained. Cirrusfin standards must be maintained at all times.

Key Performance Area Input

Financial Management

• costs within your control including telephone and printing

Clients

• Build relationships with clients and medical schemes, and know all details of the client
• Act as the interface between member/client, as well as between member/client and the Medical Scheme. Keep the channels of communication open.
• Provide factual information or advice pertaining to medical scheme as well as relevant legislation and individual scheme protocols.
• Problem solving – claims, chronic, amendments apps and ensuring penalties are not incorrectly being placed on memberships; to prevent member’s incorrectly being loaded under the wrong income bracket and thus being charged higher premiums.
• Liaise with the medical aid and other external parties when necessary, daily accurate and detailed communication and correspondence with clients, both formal and informal where required.
• Ensure when interacting with clients that you exercise perseverance, patience and good listening skills in order to deal with difficult, dissatisfied irate members.
• Always act on behalf of Cirrusfin in an ethical manner as well as ensuring honesty, integrity and transparency.
• Remain client focused at all times, ensuring that you are results and solution focused and follow through timeously as per set turnaround times

Compliance to internal processes

• Daily distribution of queries so as to maintain service levels and turnaround times as service unit manual.
• Ensuring correct procedures and protocols are followed when submitting applications to Medical Schemes.
• Ensuring that SLA is in place within the team and adhered to as well as ensuring that the medical aid’s turnaround time is also correct as per their service agreement. Deadlines must be adhered to.
• Pay attention to detail by checking of forms for completeness, prior to routing to Medical Schemes.
• Checking the status of membership applications and amendments and to follow up until membership numbers/packs are received and distributed timeously
• All interactions and queries must be noted on admin tracker.
• Following up on queries and resolving escalated problems of clients (internal/ external) in adherence to the agreed turnaround times (as per service unit manual).
• All written and verbal communication with clients (internal/ external) should be of a high standard – requesting information or advising of outcome to query efficiently and expeditiously.
• Escalate problematic queries to consultant or manager when required
• Provide feedback to the consultants and clients where applicable on queries or applications.
• Ensuring that FNA’s are issued timeously as per consultants manual and saved on CRM
• General administration, filing and updating of CRM and admin tracker on a daily basis.
• Ensuring that standard documents i.e. Minutes of internal meetings and reports are issued to Manager and Service Unit promptly after the meetings.
• Prompt, professional, friendly and helpful service at all times when dealing with clients and medical aid administrators as well as internal staff whether it is telephonically, via fax, email or in person.
• Managing the entire process of workflow- by checking daily statistics to see that there has been an equal distribution of the work load- and by pulling reports to see that people are up to date with checking their queries- these are our responsibilities

Project Management

• Contribution to business development/projects/initiatives

People

• Attend required internal and external forums and training courses

Self development

• Attending and set up frequent training sessions on the products
• Accreditation is necessary in various medical schemes products. Keeping abreast of all relevant legislative and medical scheme issues is a must.
• Ensuring Minimum FAIS credits are achieved within 1 year
• Exercising good self management skills (planning, prioritizing and time management) – self discipline

Minimum Requirements

• Formal Qualifications
  • Matric
  • FAIS accredited (120)
  • RE1
• Required Experience
  • At least 3 years experience in the Healthcare Industry
  • Healthcare Industry Knowledge

Core competencies

• Analytical Thinking & Attention to Detail
• Assertiveness (includes willingness to challenge & confront)
• Excellence / Quality Orientation
• Rule orientation
• Results & Solution Focused (Passion, Drive, Energy & Follow-through) — including Action orientation
• Customer Service Orientation (internal and/or external clients / customers)
• Relationship Building, Listening, Interpersonal Sensitivity
• Team work

TCF

• Fulfil his/her duties in such a manner that the relevant TCF outcomes are delivered
• Constructively speaks up about any TCF short-coming in any part of the business
• Quickly owns up to any mistakes or oversights he/she may be party to that may have negative TCF consequences