Medical Aid Customer Service Consultant

Purpose of the Job

The respective consultant is responsible for handling inbound calls from medical aid members, answering queries about their benefits, resolving issues related to claims, providing information on policy changes, and generally ensuring excellent customer service by adhering to medical scheme rules and regulations, all while maintaining a high level of professionalism and accuracy in a fast-paced call centre environment.

Key Responsibilities

• Responding to phone calls from medical aid members regarding their plan benefits, claim status, provider network access, and general policy questions.
• Assisting members with claim submissions, verifying eligibility, and addressing any issues related to claim denials.
• Clearly explaining complex medical aid benefits and coverage details to members.
• Updating member information on the system, including personal details and plan changes.
• Effectively addressing member complaints, escalating issues when necessary, and following up to ensure resolution.
• Staying informed about new medical aid policies, product changes, and legislative updates to accurately advise members.
• Communicating with healthcare providers regarding member eligibility and claim details.
• Efficiently navigating the medical aid system to access member information and process requests.

Required Skills

• MUST HAVE MEDICAL AID EXPERIENCE
• Excellent communication skills: Clearly explaining complex information in a concise and understandable way to members.
• Customer service focus: Prioritizing member satisfaction and building positive relationships.
• Problem-solving abilities: Identifying the root cause of issues and finding effective solutions to resolve member concerns.
• Attention to detail: Ensuring accuracy when processing member information and claims.
• Adaptability: Keeping up with frequent policy changes and system updates.
• Medical aid knowledge: Understanding medical aid terminology, benefits structures, and claims procedures.

Typical Work Environment

• Fast-paced call centre environment.
• Computer-based system to access member information and process transactions.
• Adherence to call volume and quality standards.

Desired Skills

• Excellent knowledge of the Medical Aid Industry.
• Good communication skills.
• Attention to detail.
• Understanding the core fundamentals of medical aid workflows.
• Claims processing.
• Escalation protocols.
• Writing and speaking fluent English.
• Speaking and writing an additional African language would be an advantage.
• Advanced MS Office Suites (Word, Excel, email, etc).

About The Employer

Established more than 70 years ago, Medical Aid Fund is a self-administered and restricted membership scheme that offers superior and tailor-made benefits to qualifying members in the industry. This closed scheme Medical Aid Organisation oversees an elite clientele within the financial sector.

Employer & Job Benefits

• Medical Aid.
• Pension fund.
• Statutory Benefits.