Service Consultant

at  Health Solutions

INTRODUCTION

Momentum Health Solutions, an entity of Momentum Metropolitan Holdings delivers sustainable, integrated health solutions that meet the needs of clients in the different segments and maximise lifetime client value. We build and maintain a culture of innovation and create value through unique insights of how to achieve specific outcomes by using a defined set of health capabilities.

REQUIREMENTS

• A National Senior Certificate is essential
• 2 – 3 Years’ experience in a call centre or client services environment with proven knowledge of customer service principles and practices is essential
• Exposure to the medical scheme industry would be an advantage
• A completed anatomy course would be advantageous
• Prior exposure and understanding of ICD-10 coding would be an advantage
• MS Office / Office 365 proficiency

ROLE PURPOSE

To optimise health outcomes by delivering a professional service to members through multiple channels, whilst maintaining service level agreements and compliance requirements.

DUTIES & RESPONSIBILITIES

• Engage with members and service providers to resolve queries and facilitate access to benefits within the agreed timelines and according to the documented processes and protocols.
• Facilitate members’ access to relevant information pertaining to their medical conditions, managed through the Disease Management and Wellbeing Team as well as their chronic medication.
• Accurately forward all documents for review to the correct operational systems as per the administrative workflows.
• Create and load authorisations as approved by case managers and pharmacists.
• Accurately complete all administrative and reporting requirements within agreed timeframes.
• Management of maternity gift bags including delivery, collection and stock management.
• Assist with call overflow from customer care media channels.
• Assist with projects relating to disease management and wellbeing programmes.
• Identify and report enhancements to systems and processes to improve member experience.
• Take ownership of complaints and ensure they are resolved timeously and effectively.
• Provide all stakeholders with the relevant information and documentation as require.