Escalation Officer

The Escalation Officer is responsible for resolving high priority, complex disputes and grievances that have not been settled through standard customer service channels. You will act as the final point of contact for members and stakeholders, ensuring that resolutions are fair, compliant with scheme rules, and delivered with a high degree of empathy and professionalism.

• Experience: 3-5 years in a high level claim, legal, or customer escalation environment (preferably within Medical Schemes or Insurance).
• Education: Degree or Diploma in Law, Business Administration, or a related field.
• Technical Skills: Proficiency with Administrative systems and advanced Microsoft Office skills.
• Soft Skills: Exceptional conflict resolution, negotiation, and "de escalation" verbal skills.
• Analytical Thinking: Ability to interpret complex rules and apply them to unique human scenarios.

• Case Management: Manage a portfolio of escalated complaints from start to finish, ensuring timely resolution within stipulated SLAs.
• Root Cause Analysis: Investigate the "why" behind recurring issues and provide feedback to management to prevent future escalations.
• Stakeholder Liaison: Act as a bridge between the member, internal teams, and external regulatory bodies.
• Compliance: Ensure all resolutions align with relevant industry regulations (e.g., CMS or POPIA) and scheme rules.
• Communication: Draft formal, high level correspondence and reports detailing investigation findings and final decisions.

Note: Company reserves the right to close the advert before the specified closing date.

PHA has its head office in Westville, KwaZulu Natal. It operates country wide with a nationally linked network and uses a robust, flexible, as well as integrated system to ensure efficient and effective administration of membership and benefits.