**3. KNOWLEDGE & 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.
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
Mitigating risk-ensure proper adjudication of pre authorizations / claims in line with the Old Mutual policies, e.g. enforcing of waiting periods among other terms and conditions
Collaborate with providers and clients to identify cost-effective options and implement key initiatives that maximize value for our members
Offer detailed and accurate information about Old Mutual’s provider network, policy terms, and available services
In conjunction with Smart applications resolve smart access issues raised at the point of service
Maintain accurate and timely documentation of all interactions and services provided
Escalate / liaise with claims/ care teams on any issues which require further consultation
Participate in all required training sessions and departmental meetings.
Perform general contact centre duties, including customer surveys, social media, and email management
Performs all other tasks as assigned by the Contact Center Manager or the Quality Assurance Supervisor