South Africa Job Openings
Health Solutions
Client Liaison Officer x2
Bellville
FULL TIME
August 28, 2024
- Matric Qualification
- More than 3 years' of experience preferably in a similar position within the medical aid industry.
- Relevant degree or diploma in a clinical field (advantageous).
- Excellent written skills
- Thorough knowledge of claims processing.
- Ability to maintain co-operative working relationships.
- Intermediate computer skills, Microsoft Office.
- Comprehensive knowledge of the interpretation and application of the various industry bodies, i.e. Board of Healthcare Funders (BHF), Occupational Therapy
- Association of South Africa (OTASA), Council for Medical Schemes (CMS), etc.
- Strong knowledge of hospital operations advantageous (case management, billing, etc.).
INTERNAL PROCESS
- To efficiently manage and co-ordinate existing and potential relationships between Scheme, Service Providers and Momentum Health (MH).
- To provide accurate and efficient service to MH, Scheme, Members and Service Providers.
- To ensure that exemplary services are rendered at all times to Scheme Management, Service Providers and existing Scheme members.
- To ensure that MH renders all services to the Scheme in accordance with the Service Levels and Standards as set out in the service agreements.
- To identify enhancements to the service delivery and administration, and to promote these enhancements to the MH Management Team and Service Providers.
- To provide an appropriate level of technical advice and support regarding Scheme issues.
- To assist the Scheme, Service Providers and MH with high level queries and complaints.
-
Responsibilities include:
- Classification of complaints ( General , Media , Principal officer(PO), Council (CMS) ).
- Detailed Investigation of complaints.
- Routing of complaints to various SPN.
- Drafting final written responses to Complainant and Scheme.
- Perform root cause analysis (RCA) and identify mitigation.
- Identify trends and training needs emanating from RCA.
- Assist Managers to efficiently manage and control the supporting system and Scheme Rules.
- Manage workflow and production (Service Level) for complaints.
- Liaising between MH/Scheme/Service Providers and Members.
CLIENT
- Build and maintain relationships with clients and internal and external stakeholders.
- Deliver on service level agreements applicable to clients and internal and external stakeholders in order to ensure that client expectations are managed.
- Make recommendations to improve client service and fair treatment of clients within area of responsibility.
- Participate and contribute to a culture which builds rewarding relationships, facilitates feedback and provides exceptional client service.
- Continuously monitor turnaround times and quality standards and resolve issues speedily to enhance client service delivery.
- Drive client service delivery goal achievement in line with predefined standards in order to ensure that clients receive appropriate advice and after sales service.
- Manage client query processes and ensure that queries are tracked, accurately resolved and used as a mechanism to improve client service and business processes.
PEOPLE
- Build strong relationships through providing specialist know-how and leadership to others, expressing positive expectations.
- Continuously develop own expertise in terms of industry and subject matter development and application thereof in an area of specialisation.
- Positively influence and manage change and offer specialist support where required.
- Contribute to continuous innovation through the development, sharing and implementation of new ideas and involvement of colleagues and staff.
- Participate and contribute to a culture of work centric thinking, productivity, service delivery and quality management.
- Take ownership for driving career development.
FINANCE
- Contribute to the development of area specific budgets to minimise expenditure, in alignment with operational plans.
- Identify solutions to enhance cost effectiveness and increase operational efficiency.
- Implement and provide input into governance processes, systems and legislation within area of specialisation.
- Escalate unresolved policy and governance compliance issues via appropriate channels for investigation and resolution purposes
- Provide input into the risk identification processes development and communicate recommendations in the appropriate forum.
- Relationship building.
- Teamwork.
- Client/Stakeholder Commitment.
- Attention to Detail.
- Problem Solving and Analysis.
- Emotional Resilience.
- Communication Skills (Written and verbal).
- Excellent presentation skills.
- Report writing.
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