Health Escalations Agent

The Escalations Agent is responsible for handling customer complaints queries and escalations in a professional timely and customer-focused manner.

Key Responsibilities

• Receive and manage complaints and escalations through the relevant workflow system.
• Investigate complaints by gathering all necessary information and supporting documents.
• Respond to members providers and other stakeholders clearly and professionally.
• Send first responses and ongoing updates within agreed service levels.
• Ensure complaints are resolved as quickly and effectively as possible.
• Use the correct templates and processes when communicating outcomes.
• Keep accurate records of all actions taken on the system.
• Capture the correct complaint details categories and outcomes for reporting purposes.
• Complete root cause analysis remedial actions and preventative actions where required.
• Escalate complex regulatory or sensitive matters to management when needed.
• Work closely with internal departments to obtain information and drive resolution.
• Maintain high standards of customer service quality and compliance.
• Support audit reporting and continuous improvement processes.

Qualifications :

Required

• Matric

Preferred

• RE1

Knowledge/Experience:

1-2 years experience in the  Health Insurance industry in complaints handling customer service claims or escalations is advantageous

Key Requirements

• Strong written and verbal communication skills
• Good investigation and problem-solving ability
• Strong attention to detail
• Ability to manage difficult complaints professionally
• Ability to work under pressure and meet deadlines
• Understanding of SLA-driven environments and compliance processes is beneficial

Additional Information :

Why Join Us

This is an opportunity to play a critical role in improving healthcare quality protecting patients strengthening organizational integrity and driving meaningful change. You will work alongside passionate professionals in an environment that values innovation accountability collaboration and continuous improvement.

If you are ready to make a measurable impact and help shape a safer higher-quality and more resilient healthcare organization we encourage you to apply.

Remote Work :

No

Employment Type :

Full-time