Job Duties/ Responsibilities/ Accountabilities:

• Receive calls from OHML Clients, Providers and Staff
• Receives calls from OHML enrollees and prospects
• Manages Call Centre correspondence.
• Responds to clients within approved timeline
• Responds appropriately to situations in accordance with standard care metrics
• Give pre-authorization to care
• Send daily authorization report to regional managers and medical managers
• Understand the use of IT application for customer care correspondence (CC Metrics)
• Use the CC Metrics optimally
• Escalates for update of provider directory and hospital details when received from providers
• Escalates information received to appropriate office at OHML
• Escalates complaint received to appropriate office at OHML
• Sends capitation list to providers monthly
• Calls providers to ascertain receipt of the list of enrollees
• Calls providers whenever assigned by the HOD for various communiques
• Ensure zero denial of care when informed of access request at provider facility
• Authorizes care at provider facility
• Handles referral on provider or enrollee request
• Emergency handling protocol and escalation
• Inform call-in OR e-mail clients of OHML plans
• Educate requesting call-in clients on OHML products
• Manages complaints at first contact and give feedback within stipulated time
• Co-manage care escalated from providers and clients till resolution
• Manages provider grievance emanating from OHML operations
• Coordinates the central pre-authorization system
• Coordinates the use and mastery of call center applications
• Organizes the Call Centre for optimal efficiency
• Ensure 24/7 coverage and zero shut down of the call centre operations
• Improve turn-around time for pre-authorization issuance
• Provision of PA report to relevant offices on a regular basis
• Submission of weekly CC Metrics report to Head of Medical Operations
• Submit Incident report weekly to Head of Medical Operations
• Any other task as assigned by HOD

Qualifications

• Bsc, BA.
• Minimum of 2-3 years’ experience in call center with HMO organizations is essential.
• Excellent verbal and written communication skills
• Customer Care 
• Nursing background is a plus.