Healix
Location
Esher, Surrey | United Kingdom
Job description
We have two opening for a Medical Case Manager position at Healix Health in our Bristol-based office.
Reporting to the Clinical Lead, the Case Manager (CM) will be responsible for their own caseload, providing proactive case management of high cost and complex claims (HCCCs) in liaison with all members of the healthcare team, the patient and the client. The CM will ensure that all parties have the relevant information and the member receives appropriate medical information and access to required medical services within the terms of their plan/policy, through the incorporation of NHS navigation options and cost-containment measures as standard.
We are looking for candidates who meet the following criteria:
· A good understanding and previous experience of the private medical insurance industry and claims processing, would be an advantage
· The ability to work well both independently and as part of a team
· Good problem solving and analytical skills
· Good commercial awareness with the ability to make decisions with the “bigger picture” in mind
· An overall external awareness of new technology or development within the medical sector to pre-empt and be prepared for possible related queries
· Able to interpret medical reports, write reports and other professional correspondence
· Strong diplomatic communicator at all levels; verbally and written to build and maintain internal and external relationships
· Able to demonstrate critical independent thinking and the ability to multi-task in situations where in the outcome is time sensitive.
· A high degree of accuracy and attention to detail.
· PC skills with good knowledge of Microsoft packages and the ability to effectively manage computer technology, typing and word processing.
About The Role
Key activities/main duties:
Case Management
· Maintain own caseload, ensuring a proactive case management approach through regular communication with the member, specialist and client (if appropriate)
· Using the Case Management System (CMS) for all aspects of case management
· Arrange care with an appropriate medical team / medical facility, utilising a directional approach to ensure quality and cost effectiveness of treatment
Operational
· Responsible for the provision of an efficient, cost effective and customer focused service to clients and members
· Assess eligibility of treatment within the plan/policy terms and conditions, ensuring correct processes are followed for declines, shortfalls and complaints (including in accordance with FCA regulations where appropriate)
Clinical
· Ability to liaise with clinicians (both internally and externally) to make accurate assessments based on the information provided to manage cases efficiently and ensure the very best care plan is established for members
· Provide guidance and support to the non-clinical teams to ensure members receive timely and accurate cover decisions, allowing them to progress with their treatment
Skills Needed
About The Company
We offer UK employee healthcare benefits, and travel, medical and security assistance in every corner of the globe. Our purpose is to help people in difficult situations – whether that’s a cancer diagnosis, a need for medical assistance when they’re far from home, or being caught up in conflict or natural disaster. We talk to them, support them, and make sure they get the help they need. If necessary, we’ll pull them out and bring them home.
We’re co-ordinators and problem-solvers: experts at navigating the global health and security landscape. Our teams of doctors, nurses, travel and medical co-ordinators and security experts make sure that your people will be looked after, whatever happens supported by technology designed help individuals, not slot them into a predetermined solution.
We work with governments, broadcasters, NGOs, international corporations, major insurers and more. No two clients are the same: we adapt our services to their needs.
More importantly, we adapt to the practical and human needs of the individuals we protect. Most of us are on the front line; we keep our back office lean. We don’t use scripts, and we don’t time calls. We never lose sight of the fact that we’re dealing with real people.
Company Culture
Instead, we focus on ensuring our highly trained specialists have the space and time they need to be effective. We let them use their initiative to get the job done, because the situations they face often throw up unexpected challenges – and no protocol survives contact with the real world.
Our clients have thousands of employees and customers, at home and abroad, so they need a business big enough to handle any situation. But they chose Healix because they also need an organisation that’s personal enough to care.
Our people are driven to do things in the best way, not the way they have always been done. We work hard, and our efforts are rewarded with great development opportunities and a supportive team spirit.
We want to nurture this friendly and dynamic company culture so that we can continue to attract diverse talent with a breadth of knowledge and world-class skills. As a part of Healix, you can expect a range of excellent benefits and an environment where people really do care.
Desired Criteria
Required Criteria
Closing Date Friday 29th March, 2024
Job tags
Salary
