Call Centre Officer

Responsibilities:

Receive and respond to enrollee and healthcare provider calls. Review and process requests for pre-authorisation in line with approved HMO policies and benefit plans. Issue pre-authorisation codes for approved services. Verify enrollee eligibility and benefit entitlement before authorisation. Liaise with healthcare providers regarding treatment requests and required documentation. Escalate cases requiring medical review or higher-level approval. Handle complaints relating to access to care, authorisation and provider services. Document calls, authorisations, complaints and resolutions accurately. Follow up on pending authorisation requests and outstanding cases. Maintain confidentiality of enrollee and medical information.

Requirements:

Degree 2 years experience