CUSTOMER CARE CONSULTANT

Responsible for resolution of queries in accordance with the scheme rules and legislation. Professional

Customer Care work at an advanced level involving answering phone calls and resolving queries, complaints and providing information and educating the members.

Maintain customer satisfaction ratings and deliver excellent customer service (telephonic or written) to

both internal and external stakeholders.

Record and manage query resolution within the agreed timeframe/SLA.

Following mediums used

➢ Calls (Inbound and outbound)

➢ Emails

➢ Walk-in members

➢ WhatsApp for Business

• Telephonic liaison and written response to members and suppliers
• Search files and records for information related to complaints/queries and determine solutions to the problems according to the company’s policy and procedures (telephonically or in written format)
• Liaison with members, providers, internal departments, and Healthcare partners
• Complete all related administration work.
• Provide feedback to members, Healthcare suppliers on the enquiry/complaint
• Work out quotes on dental, optometry etc. (accurate benefits and quotes to the member/provider).
• Utilise and record information using the elected systems.
• Check accounts for amendments and resubmissions.
• Validate and confirm benefits and medical scheme membership.
• Identify highly complex calls and queries to escalate to Team Leaders.
• Maintain interdepartmental processes and protocols.

• Matric with relevant experience in medical aid industry
• 2 to 4 years in medical aid industry in customer care environment
• Legislation relating to the work of medical schemes.
• Have a vast and deep understanding of the inner workings of the Medical Industry, Providers and Care
• Understanding of the nature of the Medical Scheme.
• Tariff and Nappi codes, Modifier, Practice Types, ICD 10 codes.
• Good mathematical skills
• Strong problem-solving skills.
• Excellent interpersonal communication skills and conflict resolution skills
• Good written communication skills
• Scheme Rules
• Claims Procedures
• Basic medical terminology and medical procedures and operations
• Internal systems and processes within CAMAF
• Prescribed Minimum Benefits
• Chronic Diseases List
• Benefit options
• South African Medical Association
• Managed Healthcare partners
• Preferred Provider Network etc.
• Computer literacy: provisioned in MS word and Excel and know how to navigate other software programs

Please send your CV and supporting documents to Demi-Lee email: Sign in to view email

If you have not received any feedback within 2 weeks please consider your application was unsuccesful