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

·       Log into the clinical Call centre daily on time

·       Interview members and Drs upon calling

·       Educate members on benefits such as Member Management Assistance Programme

·       Educate  member on the difference between GP consultation  and Virtual consultation benefits

·       Advise members on the effects of further management and refer to correct specialist

·       Refer member for  nurse consultation at a contracted pharmacy for minor ailments such as temperature, fever etc

·       Load valid Dr’s consultation events on valid request

·       Activate extra benefits for deserving members such as more than the required benefit 

·       Understand the benefit of different medical Insurance and Medical Aid differently

·       Access different systems to verify membership and plan type

·       Load virtual consultation and allocate time with the Chief Medical Officer

·       Respond to clinical enquiries from general call centre

·       Understand claims benefits and be able to explain to member

·       Maintain Service Level agreements on call volume

·       Load specialist auth numbers from the Case managers email address.

·       Basic understanding of Chronic Disease List

·       Ability to refer members to the correct department

·       Be comfortable to discuss HIV as an extra condition on enquiry

·       Understand the access to benefits  on different plan and policy options

KEY OUTCOMES

Maintain Service levels above 85%

Be willing to assist the Patient managers   with in-coming calls .

Ability to maintain confidentiality as dealing with client clinical information

Continuous support of members in need of help and

Increase member satisfaction and understanding of benefits

Ability to work well under pressure

Be a team player 

Reliable, dedicated and professional

SPECIAL REQUIREMENTS

Experience in the medical aid Industry

Confidence t deal with DR’s and members

PERSON DETAILS : WORK EXPERIENCE

REQUIRED

Knowledge of the medical terminology

Work in the medical aid industry

Call centre experience will be an advantage

PREFERRED

EDUCATION : QUALIFICATIONS : ACCREDITATIONS WITH PROFESSIONAL BODY

REQUIRED

·       An enrolled nurse with an enrolled Certificate /or a Registered Nurse 

·       Registration with the SANC

·       Knowledge and experience of the medical industry

·       Ability to speak more than 1 African language will be an advantage

·       Basic understanding of the ICD 10 codes

·       Ability to show empathy  

PREFERRED

TECHNICAL SKILLS OR KNOWLEDGE

REQUIRED

Attention to detail

Computer literate

Microsoft Access

Clinical discretion

PREFERRED

Computer literacy.

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