Lets Write Africa's Story Together!
Old Mutual is a firm believer in the African opportunity and our diverse talent reflects this.
Job Description
Key Tasks and Responsibilities
- Pre-Authorization of all admissions within 6 hours and technical guidelines.
- Minimize identifiable cases of fraud/abuse
- To resolve customer queries over the phone and offer solutions to the customers in a timely manner
- Supervise Pre-authorization of scheduled and non-scheduled admissions within the set guidelines and carry out verification and medical Audit of claims/invoices before settlement.
- Managing requests for services from providers, intermediaries and clients, providing information on the UAP Old Mutual provider network and available benefits per scheme policy
- In conjunction with SMART applications resolve card issues raised at the point of service
- Authorization of all optical requests from the different providers within 6 hours and prepare daily reports
- To attend to reimbursements from the different providers in a timely manner and provide daily reports.
- Liaise with other medical schemes for purposes of evaluating medical risk.
- To formulate committal letters of discharges as a result of the requests from the different service providers. ANTI-MONEY LAUNDERING (AML) EXPECTATION
- The incumbent will be responsible for ensuring adherence to, implementation of, and adoption of Compliance, Anti-Money Laundering (AML), and Sanctions-related policies, procedures, and process requirements within Old Mutual and its subsidiaries. This includes execution of customer due diligence processes, ensuring compliance with Know-Your-Customer (KYC) standards, conducting ongoing and enhanced due diligence, and maintaining data quality. Additionally, the role involves identifying and monitoring potential AML, Sanctions, or Compliance breaches and unusual activities, and escalating these concerns to the Risk and Compliance Office for further action.
Qualifications
Degree/ Diploma in Nursing
Diploma in insurance
Skills and Competences
- Excellent communication and negotiation skills
- To always keep time at the start of your shifts.
- Excellent public relations and interpersonal relationship skills
- Excellent networking with SP and other medical insurers
- Excellent analytical and monitoring skills
- Ability to work with speed and accuracy
- Strong Computer skills in Ms Word, Excel, Power Point and Ms Outlook
- Result – oriented, adheres to turn around times
- Strong teamwork spirit
To provide a positive customer experience by being helpful and sensitive to customer needs, managing expectations and providing solutions including directing customers to the correct channel in adherence to procedural, productivity and quality standards. Has a good understanding of products and services.
Responsibilities
Product/Service Information
Provide advanced product/service information.
Customer Order Processing
Record and process customer orders, selecting the most appropriate approach based on predefined options.
Resolving Customer Issues
Respond to basic and advanced customer issues, such as returns, exchanges, and complaints; escalate appropriately.
Customer Relationship Development / Prospecting
Make calls (by telephone or in person) to allocated potential customers to develop relationships. Provide a first point of contact for resolving customer queries and complaints.
Customer Relationship Management (CRM) Data
Enter relevant information into the CRM system after each contact with a customer to ensure that the organization has quality data to enable effective customer retention and business development activities.
Customer Needs Clarification
Interview the customer, following a multilevel sales script, to clarify the customer's requirements.
Renewals
Provide exceptional service to customers to encourage continued use of the organization's products/services.
Operational Compliance
Develop working knowledge of the organization's policies and procedures and of regulatory codes and codes of conduct relevant to own work, adhering to mandatory procedures to ensure own work is undertaken to the required standards.
Personal Capability Building
Develop and maintain excellent process or technical skills by participating in assessment and development planning activities as well as formal and informal training and coaching.
Skills
Analytical Thinking, Analytical Thinking, Coaching, Codes of Conduct, Communication, Computer Literacy, Consultative Selling, Customer Complaint Management, Customer Due Diligence (CDD), Customer Experience (CX), Customer Feedback Management, Customer-Focused, Customer Relationship Development, Customer Relationship Management (CRM), Customer Relationship Management (CRM) Software, Customer Relationship Management (CRM) System, Customer Relationships, Customer Retentions, Customer Service, Customer Service Operations, Customer Understanding, Data Management, Development Planning, Digital Consumer Engagement, Due Diligence {+ 15 more}
Competencies
Action Oriented
Communicates Effectively
Customer Focus
Decision Quality
Ensures Accountability
Instills Trust
Interpersonal Savvy
Nimble Learning
Education
Bachelors Degree (B): Nursing (Required)
Closing Date
17 December 2025 , 23:59
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