Quality Assurance Officer – Call Center at Old Mutual Kenya

Job Overview

We are looking for a highly competent, result-oriented medical professional with focus on quality improvement within the call center.

The QA officer will ensure that customer service and interactions meet the company’s standards for quality, accuracy and customer satisfaction by identifying areas of improvement and working with different teams to ensure cost-efficiency throughout the process.

Key Responsibilities:

• Monitor customer interactions
• Review calls, emails, chat logs and any other customer interaction channel to assess quality and accuracy of the information
• Ensure that the call center agents follow and adhere to call scripts, handle calls within acceptable matrix, maintaining professionalism and resolving issues efficiently.
• Ensure that agents use correct systems, tools and processes to handle customer enquiries.
• Evaluate Outpatient requests adherence to standards
• Review outpatient requests to identify any emerging trends and issues
• Identify areas of concern from a cost and quality perspective to enable address them with the medical service providers.
• Identify issues and exposure that require to be addressed from a policy perspective, liaising with underwriters by making recommendations.
• Monitor and review outpatient turnaround times to ensure efficiency.
• Outpatient approvals
• Identify and drive cost saving initiatives
• Monitor accuracy of approvals and declines and the process associated with each.
• Ensure accuracy in approvals and declines and how these are communicated to providers and customers.
• Standardize outpatient approvals across clinical teams to ensure consistency.
• Provide feedback and coaching
• Deliver feedback with agents on their performance highlighting areas of strengths and identifying areas of improvement.
• Identify gaps and opportunities, providing recommendations for Continuing Medical Education (CME).
• Track and report key matric e.g. NPS, NES and FCR
• Share insights with management to help drive process, product and system improvement.
• Documentation and reporting
• Documentation of all quality assurance and control activities
• Review and approve quality related documentation such as SOPs
• Prepare quality performance reports to senior management, highlighting key quality metrics, audit findings, and improvement initiatives.
• Support continuous improvement
• Proactively suggest process or procedural improvements based on customer feedback and observed performance and industry trends.
• Promote a culture of continuous improvement within the team

EDUCATIONAL QUALIFICATIONS

• Bachelor’s degree in clinical medicine, Nursing, or Health Systems Management.
• Registered and certified by the relevant professional council (e.g., Nursing Council, Clinical Officer Council).
• Professional Certifications in quality management is an added advantage.

SKILLS AND EXPERIENCE

• Minimum of 3 years of experience in Quality Assurance in a health insurance environment.
• Attention to details
• Excellent verbal and written communication skills
• Analytical thinking
• Problem solving
• Team collaboration.