Membership Clerk: Quality Controller
To perform quality control activities on all workflow transactions to ensure accuracy in data entry and adherence to Standard Operating Procedures and Scheme rules within the agreed Service Levels. -Check and verify the accuracy and completeness of data captured on workflow against the application forms and ensure correctness. -Check and verify that the clinical underwriting that was applied by the underwriter is accurate and in line with the Scheme underwriting Rules and Medical Scheme Legislation.-Coach staff on errors identified.-Activate application forms upon QC completion.-Investigate, and resolve customer queries in accordance with Standard Operating Procedures within the agreed Service Levels and providing feedback to the query requester on the outcome of the query.-Assist with compiling of monthly membership reports and adhere to set reporting standards.-Provide sub-divisional training and coaching for team members to enhance data integrity and business optimisation. -Ensure the Membership sub-division has a thorough understanding of the Medical Schemes Act principles and regulatory provisioning guidelines.-Identify areas of improvement to increase speed, quality and gain efficiencies.-Recommend improvements and identify gaps in Standards Operating Procedures relating to Membership.-Assist in identifying and adhering to fraud controls, risk prevention principles, sound governance and compliance processes, and tools to identify and manage risks.-Support and provide evidence to all internal, external and ISO audit requirements.-Maintain quality risk management standards in line with the requirements from ISO9001:2015.-Maintain and enforce all membership related Service Level Agreements to minimise business risk and ensure business continuity. -Identify and recommend improvements to credit control related Standard Operating Procedures and guidelines in consultation with the Supervisor and Manager: Membership to ensure business optimisations. -Adhere to all relevant laws, policies and Standard Operating Procedures throughout the organisation-Build and maintain effective internal and external stakeholder relationships for the purpose of expectations management, knowledge sharing and integration. -Liaise with members, brokers and 3rd parties in delivering exceptional customer service.
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