Healthcare Claims Coordinator

4 weeks ago

Tewkesbury, Gloucestershire, United Kingdom Health and Care Management Ltd Full time
About the Position

Healthcare Claims Coordinator

Our organization is seeking a dedicated individual to join our team as a Healthcare Claims Coordinator. This role is essential in ensuring a seamless experience for all members navigating claims through their healthcare plan.

Key Responsibilities:

  • Identify the primary reasons for health issues or injuries and explore any underlying causes or contributing factors.
  • Assist in the multidisciplinary assessment process by providing comprehensive and precise information to evaluate personal and occupational risk factors.
  • Guide members on the reasons and multifactorial issues related to their current health challenges and empower them to take proactive steps in managing these issues.
  • Adhere to managed care pathways, NICE, and other evidence-based clinical guidelines.
  • When necessary, review both private and NHS treatment options for referrals to consultations, investigations, and treatments.
  • Identify suitable treatment providers in accordance with the stipulations and benefits of their health insurance plan.
  • Stay informed about the latest rules and benefits of each plan offered by our corporate clients, including any changes or exceptions.
  • Collaborate effectively with our onsite Functional Health team to manage referrals and deliver a comprehensive service.
  • Oversee the claim process from initiation to conclusion, ensuring all relevant parties are informed and our CRM system is updated with all actions taken.
Essential Skills and Experience:

Key Skills:

  • Proficient in Microsoft Office applications and comfortable utilizing IT systems.
  • Exceptional communication abilities, both verbally and in writing.
  • Possess an investigative and problem-solving approach.
  • Effectively manage workloads to meet customer service deadlines and expectations.

Required Experience:

  • Experience in an insurance or claims environment, particularly in healthcare.
  • Understanding of clinical and non-clinical pathways.
  • Capability to conduct telephone assessments.

Desirable Experience:

  • Clinical qualifications such as Sports Therapy, Physiotherapy, Nutrition, or Counselling.
  • Familiarity with GDPR, DPA, and ICO regulations regarding customer information protection.
Diversity and Inclusion:

Health and Care Management Ltd is committed to providing equal opportunities for all employees and encourages applications from individuals regardless of age, disability, gender, sexual orientation, race, religion, or any other characteristic.

Benefits:
  • 25 days of annual leave.
  • Your birthday off.
  • 6% company pension contribution.
  • Bike to Work Scheme.
  • Medicash Health plan.
  • Enhanced leave options for maternity, paternity, adoption, and shared parental leave.
  • Two voluntary days per year.
  • Long Service Awards.
  • Employee Wellbeing Seminars.
  • Continuing Professional Development opportunities.
  • Professional memberships covered (role dependent).

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