Job Vacancies at MetroHealth HMO Limited

Scope of Work

The primary duties of the Call Centre Executive will include:

• Provide product and service information to clients
• Managing inbound and/or outbound calls from customers, distribution partners and providers.
• Manage and resolve customer complaints

Responsibilities

Responsibilities include the following:

• Respond to all Enrollee and Provider inquiries in a friendly, professional manner using the suggested script.
• Keep up-to-date information on all plans of GHML and tariff and communicate same to customers in a professional manner.
• Explain benefits, eligibility status, enrollment processing procedures and status of authorizations and referrals to callers.
• Provide up to date information about company products and services to clients, providers and billing agencies.
• Grant authorizations code for medical treatment, if covered on the plan.
• Proffer on-the-spot solution to enrollee challenges.
• Escalate challenges to line managers
• De-subscription of members' plans upon their request, or due to recurrent non-payment, if directed by your line manager.

Requirements

• Must possess a Nursing Certificate.
• At least 2 years relevant work experience

Required Skills:

• Good communication/presentation skills (both oral and written)
• Excellent customer relationship skills
• Proficiency in the use of Microsoft Office Packages
• Good Typing Skills
• Attention to detail
• Ability to work as a team player
• Good Coordination, administrative, Analytical and problem-solving skills.

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Job Description

• Review daily inprocess report for new assigned claims
• Request documentation from Office Assistant needed to complete clinical review of assigned claims
• Review coding of professional bills utilizing requested procedural notes
• Review itemized bill and medical records for medical appropriateness and inconsistencies by performing a line by line clinical review of claim
• Research unfamiliar procedures as needed via web
• Contact provider's representative to resolve billing issues
• Contact provider's representative to negotiate claim
• Confirm repricing information with provider
• Provide status of outstanding claims upon request
• Prepare management reports of findings for submission to clients

Requirements

• The ideal candidate must be a Registered Nurse
• Should posses minium of 2 years experience (HMO experience will be an added advantage).