Medical and Quality Assurance Nurse at Prepaid Medicare Services Limited

Summary

• To answer and or/initiate customer calls, respond to customer needs in a professional, service-oriented manner and maintain the highest level of customer satisfaction by seeking first call resolution.
• Modelling effective communication skills, call centre agents must be knowledgeable about the products and services of Prepaid Medicare Services Ltd HMO.

Key Responsibilities

Include the following. Other duties may be assigned.

• Ensures the enrolees have seamless access to healthcare
• Function as an information source through telephonic assistance to members, providers, billing agencies, and various company/department staff.
• Provide pleasant customer experience through superior customer service methods, problem solving and real-time issue resolution.
• Interact with provider community and various departments to resolve issues involving the membership and credentialing status.
• Explain benefits, eligibility status, enrolment processing procedures and status of authorizations and referrals to callers.
• Conduct member outreach calls as assigned to proactively educate members on services available (Welcome Calls).
• Process complaints, following established guidelines.
• Maintain knowledge of National guidelines, regulations, and departmental policies and practices and maintain accurate documentation for compliance.
• Answer calls professionally and respond to customer inquiries
• Identify and escalate priority issues.

Requirements

• Must be a certified Registered Nurse with 3 to 5 years of experience
• Ability to communicate effectively in both oral and written English language Must be a team player, able to build and maintain effective and collaborative sales and marketing network
• Must be able to take responsibility and demonstrate high level of integrity in dealing with all stakeholders
• Excellent customer relationship skills Good communication/presentation skills (both oral and written)
• Must be willing to resume work 3 days after interview.
• Must be willing to work 24 hours Knowledge of the operations of the National Health Insurance Scheme (NHIS) and Health Maintenance Organization will be an added advantage.