Clinical Risk Consultant
Oneplan
Midrand, Gauteng, ZA
3d ago
source : Careers24

A vacancy has arisen in our Health Claims Department. We are looking for a dynamic and passionate Authorisations Consultant to join our team.

Duties will include but not be limited to; Clinical Risk Management by underwriting, validations of authorizations according to protocol and claims auditing.

Provide support and education to clients relating to their claims queries, processes and the policy. Project a professional company image through phone interaction.

Key Result Areas : Underwriting, Claim processing and Customer / Provider Service Underwriting according to protocol and to ensure effective risk management Validation of authorisation of claims based on policy terms and conditions Timeous and accurate assessing of claims Maintain customer / provider relations Assist with staff and provider training and support Answer phones and respond to customer requests within the determined SLA Explain products and update customer details in computer syste Provide customers with product and service information via appropriate methods (telephonically / email) Identify, research, and resolve customer issues using the computer system Follow-up on customer queries not immediately resolved, within determined SLAs Complete call logs and reports Educate clients on claims process.

Assist and resolve claim queries. Follow and adhere to claims / company processes, procedures and protocol Recognize, document and alert the supervisor of trends in customer calls Recommend process improvements Focus on first call resolution as far as possible Other duties as assigned from time to time Operational Effectiveness Be punctual Complete accurate and timely administration Submit to the manager all relevant reports, paperwork and update on all call or claims activity as directed, in a timeous manner Any additional responsibilities as required from time to time Comply with company policy and procedures at all times Candidate Requirements Knowledge Relevant B-degree / diploma (essential) Literacy - read and write English Pc Literacy- word, excel, email and internet Minimum three (3) years working experience in a case management capacity Skills Excellent communication skills - written, verbal and internal.

Active listening and strong negotiating skills The ability to resolve problems and disputes with clients and arrive at decisions which allow the business to move forward Display an understanding and knowledge of the product, industry and target audience Actively participate in team meetings and use your market knowledge to assist the clients effectively Ability to work in a team orientated environment Computer literate Ability to work shifts (including night / weekends) Attributes Ability to work independently and self-manage Maintain initiative and pro-activeness Maintain integrity, responsibility and accountability Ability to meet deadlines within time constraints Ability to be effective in a pressurized environment

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