Call Center Care Manager at Madison Group Limited

Overall Responsibility:

To pick all calls directed to the medical call center and assign them to the relevant people; and handle client complaints and queries in order to improve the efficiency of the care team.

Key Responsibilities

• Pick all the calls directed to the, Medical call centre both main and back-up line and handle the clients to their satisfaction.
• Respond to all Outpatient, Optical and dental preauthorization requests while adhering to schemes rules and provider rules
• Respond to potential/existing customer inquiries by providing and/or clarifying with the desired information.
• Inform clients and service providers by explaining procedures and answering questions through inbound calls.
• Resolves complaints by clarifying issues and exploring answers and alternative solutions, implementing solutions, and escalating unresolved complaints.
• Complaints management by proper escalation of client and service provider queries.
• Follow up for end to end resolution on all issues raised by both clients and providers.
• Ensure strict process compliance in line with the business lines objective.
• Maintain and improve quality results by adhering to standards and guidelines, recommending improved procedures.
• Pick insights from clients and provider feedback on product and process improvement, and report them to the relevant people in a timely manner.
• Generate reports on the various engagements and feedback collected

Skills and Competencies Required

• Health Benefits Plan Management
• Policy Interpretation
• Customer Service and Focus
• Ownership & commitment
• Team Spirit
• Excellent communication
• Ability to multi-task
• Strong negotiation and decision-making skills

Knowledge & Experience

• At least 2 years’ experience in a medical insurance call centre environment
• Demonstrated knowledge of handling calls and approvals
• Demonstrated experience in engaging clients, service providers and doctors
• Demonstrated experience in customer complaints management

Academic and Professional Qualifications required

• Bachelor’s degree in Clinical Medicine or Nursing
• At least two-year’s experience in a medical call center in a busy medical insurance.