Kaelo provides essential healthcare solutions ensuring the physical and psychosocial wellbeing of all South Africans towards lasting social change.

The Kaelo Health Specialised Servicing Consultant is responsible for responding to complex queries, managing complaints, troubleshooting service problems and providing general information regarding our products. Manage our customer and provider experience with excellence and accuracy. As a Specialised Consultant you will be expected to perform using a variety of channels, including telephonic and correspondence as well be skilled on all Kaelo products. Management of the provider relationship from contracting , service level agreements, administration , reporting.

Key Outcomes

Manage networks

-          Rango appointment management and reporting on the Halo network

-          Management of authorisations

Grow and maintain network providers

- Maintain contact information and communicate and store according to the business rules and requirements

-          Maintain on-boarding and off-boarding of health providers

-          Maintain client information  

Resolve network related escalations

• Ensure maintenance of SLA’s and correct escalation protocols are adhered too
• Source and contact health providers
• Report on networks and appointments
• Weekly and monthly reporting , but not limited to this frequency
• Negotiate annual tariffs

Manage incoming queries and outbound responses with:

• Members
• Service Providers
• Intermediaries
• Health Providers
• RAF (Road accident fund)requests manage relationship with third party stakeholder

Manage omni-channel responses (including telephonic and correspondence) 

Provide product specific information across full product suite

Assess and determine when there is an operational query and or complaint

• Identify and escalate priority issues

Manage and resolve customer and health provider complaints

Complete administrative tasks

Continuous improvement and quality assurance

-          Monitor and manage trends

-          Conduct root cause analyses

PERSON DETAILS : WORK EXPERIENCE

REQUIRED

·       At least 3 years’ experience in the Medical Scheme or Healthcare Industry in a data administration role

·       Knowledge of customer service practices and principles

·       Excellent listening, verbal and written communication skills

PREFERRED

-          Proven work experience in the Healthcare administration or managed care environment

EDUCATION : QUALIFICATIONS : ACCREDITATIONS WITH PROFESSIONAL BODY

REQUIRED

·       Grade 12 or equivalent NQF 4 certificate

PREFERRED

·       Grade 12 or equivalent NQF 4 certificate

TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

·       Computer Literacy – Microsoft Excel, Word and PowerPoint

·       Strong phone, email (written) and inter-person communication skills

·       Call centre systems and multi-tasking

PREFERRED

Knowledge of Medical Scheme Industry

Ability to maintain confidentiality, problem solve, negotiate and communicate, attention to detail. Ability to handle stressful situations appropriately

1.      Accountability
2.      Action orientated
3.      Communication
4.      Business writing skills
5.      Manages complexity
6.      Problem solving skills
7.      Encourages engagement
8.      Planning and organisation
9.      Resilient and adaptive
10.      Systems thinking and connecting ability
11.      Purpose driven
12.      Significance and values orientated