Tamheer - Quality Enrollment

• Handle all cases received from RM's with high quality and ensure proper resolution within the KPI's
• Liaise with all areas in operations and beyond to resolve cases escalated by RM's
• Keep a daily tracker/record of all pending and closed cases and monitor resolution time
• Ensure that the RM has been informed with the outcome of all cases
• Ensure that Customer Care contacts the members involved when needed
• Investigate complaints that have been escalated by RM's and resolve and draft an official reply
• Keep record of the complaints and share with the Quality team
• Ensure acknowledgement, investigation, and official reply within the agreed KPI
• Assist in conducting analysis of the database collected and use results to improve processes and KPI’s
• Support in the creation of Dashboards for all Servis account activities and circulatethem internally
• Take In bound calls from RM and either answer queries on the spot or transfer to the list
• Transfer any cases to the concerned dept. and ensure proper resolution
• retrieve supporting documents
• Areas related to Reimbursement, PR, CS, HCO, PA, Finance, .etc.
• Review all commercial and ex gratia approval requests from RM’s and escalate to the concerned person in the authority matrix
• Process the approval through CAESAR while liaising with preauthorization and update the RM with the outcome
• Maintain the commercial budget record, update regularly and communicate the report to the direct manger on a monthly basis

Bachelors Degree in Business Administration, Finance Or Healthcare.

• Multi-Cultural with very good communication skills
• Deep understanding of CCHI & regulations
• Knowledge in the insurance and medical terminology is a major advantage.
•  Service mindset