If this vacancy is of interest to you, please send a CV to email@example.com or give us a call on 0208 549 7212.
You will be working in liaison with the Health Services team and reporting to the Operations Manager.
You will be required to provide a professional and high standard of customer service at all times.
You will liaise with all members of the healthcare team, and the client to ensure that all parties have the relevant information, and the patient receives appropriate medical information and access to required medical services.
• To represent the client and/or the company in a professional manner at all times.
• To take calls from clients, providers and specified members in relation to initial and/or ongoing claims.
• Answer incoming calls promptly and within SLAs, providing the highest level of customer service at all times.
• Obtain medical evidence from providers to substantiate claims decision/treatment.
• Deal with provider queries in relation to clinical treatment or pre-authorisation requests.
• Arrange care with the appropriate medical team/facility.
• Ensure treatment delivered is relevant and appropriate by monitoring ongoing treatment plans for members in liaison with the Clinical Support Team (CST) and Medical Case Manager.
• Negotiate provider fees to within the company’s Reasonable and Customary fees, as part of cost containment for clients where possible.
• Escalate any complaints in a timely manner to your direct line manager.
• Ensure all documents are correctly allocated on Case Management System.
• Maintain accurate record keeping.
• Responsible for managing reminders and any outstanding actions.
• Adhere to all internal processes and procedures at all times.
• Provide feedback, and assisting in the development of standard operating procedures and protocols.
• Further tasks deemed appropriate by your line manager and/or the Management Team.
• Undertake other business activities and tasks as required ensuring ongoing operational effectiveness, efficiency and positive contribution to the company.
We are looking for an individual with the following areas of expertise:
• Keeping up to date on all our clients’ requirements and able to locate and interpret all relevant policy documentation.
• Excellent written and oral communication skills.
• Decision making skills and ability to use own initiative and work independently.
• A diplomatic open style and approach, with excellent verbal and written communication.
• A high degree of accuracy and attention to detail.
• A good understanding and previous experience of the private medical insurance industry and claims processing, would be an advantage.
• PC skills with good knowledge of Microsoft packages.
• The ability to demonstrate customer led thinking.
• Proactive approach to work and analytical problem solving skills.
• The ability to plan and organise own workload, and work well under pressure.
• The ability to work well both independently and as part of a team.
• Although we operate a shift policy, the candidate will need to be able to demonstrate flexibility when required, to fulfil time sensitive tasks.
• Good problem solving and analytical skills.
• Good commercial awareness with the ability to make decisions with the “bigger picture” in mind.
• Ability to identify when it becomes appropriate to escalate a problem.
• Ability to make effective contact with clinicians, accurate assessment of information obtained and acting appropriately upon the outcome.
• An overall external awareness of new technology or development within the industry to pre-empt and be prepared for possible related queries.