Job Ref. No: JHIL141

Role Purpose

The primary purpose of the Care Executive is to assist customers with their medical insurance inquiries and providing exceptional service. The Care Executive will be responsible for addressing customer concerns, explaining policy details and ensuring a positive customer experience.

Key Responsibilities

• Review and process preauthorization requests for medical procedures and treatments.
• Communicate preauthorization decisions to healthcare providers and policyholders.
• Ensure compliance with preauthorization policies and guidelines.
• Respond to customer inquiries related to medical insurance policies, claims, and coverage.
• Provide accurate information about benefits, eligibility, and claim status.
• Assist customers in navigating and understanding insurance documents and policy terms.
• Assist customers in making informed decisions about their insurance coverage based on their individual needs.
• Investigate and resolve customer complaints or concerns promptly and effectively.
• Collaborate with relevant departments to escalate and resolve complex issues.
• Maintain clear and concise communication with customers through various channels, including phone, email.
• Ensure a high level of professionalism and empathy in all interactions.

Key Skills and Competencies

• Conflict resolution and negotiation skills.
• Proficiency in relevant software tools and case management systems.
• Effective communication and interpersonal skills.
• Strategic decision-making prowess.
• Thorough understanding of healthcare regulations and insurance practices.
• Clinical knowledge and medical expertise.

Academic & Professional Qualifications

• Bachelor’s degree or a Diploma in a Medical field

 Relevant Experience

• A minimum of one (1) year of relevant working experience.