Job Description
The Contact Centre Clinical Executive is responsible for delivering efficient, accurate, and professional customer support through multiple communication channels, including phone calls, email, and other available platforms.
KEY TASKS AND RESPONSIBILITIES
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.
SKILLS AND COMPETENCIES
Communication Skills: Clear, concise, and courteous verbal and written communication
Problem Solving: Able to assess issues quickly and take appropriate action or escalate where necessary
Attention to Detail: Ensures accuracy in processing requests and documenting interactions
Teamwork and Collaboration: Works effectively with internal teams (e.g. BPU, Relationship managers, case management, claims), Intermediaries and external service providers
Customer Service Excellence: Demonstrates professionalism, empathy, and efficiency in all client interactions
Technical skills: Proficiency in handling contact centre systems (e.g., telephony, CRM platforms, email management tools) .
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.