​Care Officer – Call Centre at GA Insurance

Job Summary: This position is responsible for providing efficient and effective customer service to all GA Insurance Limited's internal and external customers with utmost level of consistency and quality.

Duties and Responsibilities:


Attend to client's general queries i.e., answering calls from all customers regarding membership eligibility, claim status, benefit information, and claim payments and/or denials
Inform clients through calls by explaining procedures; answering questions; providing needed information.
Ensure medical pre-authorizations/undertakings/ admissions / discharges /declines are issued in compliance with the policy provisions and as per the authority limits.
Ensure that issues escalated, either through emails or calls, are resolved within stipulated timelines to ensure customer satisfaction and loyalty.
Liaise with doctors, brokers and clients via phone or emails for patient admissions.
Advise members on how best to utilise their benefits by recommending cheaper facilities and cheaper options e.g., maternity packages, chronic management facilities
Log claims on the system on a timely basis.
Monitor the turnaround time on email response by logging in the time emails are received on the care team email address
Liaising with our underwriters for scheme membership / benefit / members / dependants missing details in the system and scope of cover
Proper handing over of admissions and discharges above the authorized limit to the care nurse/ care senior officer


Complaints Management and Audit Compliance


Observe guided information to clients and relevant authorized parties are done in compliance with the Data Protection Act
Receive customer complaints or queries and document the same
Follow up on the complaints and ensure they are resolved within set service level agreements.
Communicate feedback to clients
Participate in the process of identifying service gaps and give feedback on necessary corrective measures.
Ensure that all issues are assigned to relevant parties and closed.
Ensure follow-through of the set-out policies and procedures.


Academic and Professional Qualifications


Bachelor's Degree/Diploma in Nursing (KRCHN), Health Management or in a related field.
Possession of Health System Management qualifications would be an added advantage.
Kenya Registered Nurse/Kenya Registered Community Health Nurse
Additional training in customer service is an added advantage.


Experience


At least 2 years of experience in a similar role and industry


Technical Competencies


Proficiency in MS Package
Conversant with medical terminology to explain benefits and claims clearly.
Knowledge of insurance industry and concepts
Knowledge of insurance regulatory requirements
Working knowledge of customer and relationship management
Demonstrated experience in customer management and query resolution within care management


Behavioural Competencies


Demonstrated empathy and understanding in handling client concerns.
Actively listening to accurately identify and address customer needs.
Ability to multitask interactions and tasks efficiently.
Strong customer service
Strong analytical and problem-solving skills
Results driven and action oriented
Collaborative team player
Strong attention to detail
Agile mindset with demonstrated ability to manage tasks with competing deadlines
High degree of emotional intelligence, integrity, trust and dependability.
Ability to work independently as well as part of a team.