​Care Officer – Call Centre

Position Overview

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

Duties and Responsibilities

• Attend to client queries by answering calls regarding membership eligibility, claim status, benefit information, claim payments, and claim denials
• Inform clients by explaining procedures, answering questions, and providing necessary information
• Ensure medical pre-authorizations, undertakings, admissions, discharges, and declines are issued in compliance with policy provisions and authorized limits
• Resolve escalated issues through emails or calls within stipulated timelines to ensure customer satisfaction and loyalty
• Liaise with doctors, brokers, and clients via phone or email for patient admissions
• Advise members on optimal benefit utilization by recommending cost-effective facilities and options such as maternity packages and chronic management facilities
• Log claims on the system on a timely basis
• Monitor email response turnaround times by logging receipt times on the care team email address
• Liaise with underwriters regarding scheme membership, benefit information, missing member or dependent details, and scope of cover
• Hand over admissions and discharges exceeding authorized limits to the care nurse or care senior officer

Complaints Management and Audit Compliance

• Ensure all client and relevant authorized party communications comply with the Data Protection Act
• Receive and document customer complaints and queries
• Follow up on complaints and ensure resolution within set service level agreements
• Communicate feedback to clients
• Participate in audit compliance processes