Job Summary: 

• This position is responsible for providing efficient and effective customer service to all GA Insurance Limited’s internal and external customers with utmost level of consistency and quality.

Duties and Responsibilities:

• Attend to client’s general queries i.e., answering calls from all customers regarding membership eligibility, claim status, benefit information, and claim payments and/or denials
• Inform clients through calls by explaining procedures; answering questions; providing needed information.
• Ensure medical pre-authorizations/undertakings/ admissions / discharges /declines are issued in compliance with the policy provisions and as per the authority limits.
• Ensure that issues escalated, either through emails or calls, are resolved within stipulated timelines to ensure customer satisfaction and loyalty.
• Liaise with doctors, brokers and clients via phone or emails for patient admissions.
• Advise members on how best to utilise their benefits by recommending cheaper facilities and cheaper options e.g., maternity packages, chronic management facilities
• Log claims on the system on a timely basis.
• Monitor the turnaround time on email response by logging in the time emails are received on the care team email address
• Liaising with our underwriters for scheme membership / benefit / members / dependants missing details in the system and scope of cover
• Proper handing over of admissions and discharges above the authorized limit to the care nurse/ care senior officer.

Complaints Management and Audit Compliance

• Observe guided information to clients and relevant authorized parties are done in compliance with the Data Protection Act
• Receive customer complaints or queries and document the same
• Follow up on the complaints and ensure they are resolved within set service level agreements.
• Communicate feedback to clients
• Participate in the process of identifying service gaps and give feedback on necessary corrective measures.
• Ensure that all issues are assigned to relevant parties and closed.
• Ensure follow-through of the set-out policies and procedures.

Academic and Professional Qualifications

• Bachelor’s Degree/Diploma in Nursing (KRCHN), Clinical Medicine & Surgery, Health Management or in a related field.
• Possession of Health System Management qualifications would be an added advantage.
• Kenya Registered Nurse/Kenya Registered Community Health Nurse
• Additional training in customer service is an added advantage.

Experience

• At least 2 years of experience in a similar role and industry

Technical Competencies

• Proficiency in MS Package
• Conversant with medical terminology to explain benefits and claims clearly.
• Knowledge of insurance industry and concepts
• Knowledge of insurance regulatory requirements
• Working knowledge of customer and relationship management
• Demonstrated experience in customer management and query resolution within care management.

Behavioural Competencies

• Demonstrated empathy and understanding in handling client concerns.
• Actively listening to accurately identify and address customer needs.
• Ability to multitask interactions and tasks efficiently.
• Strong customer service
• Strong analytical and problem-solving skills
• Results driven and action oriented
• Collaborative team player
• Strong attention to detail
• Agile mindset with demonstrated ability to manage tasks with competing deadlines
• High degree of emotional intelligence, integrity, trust and dependability.
• Ability to work independently as well as part of a team.