Medical Claims Advisor(s) - Healix Health Services

Salary: £19,500 to £21,500

Location: Esher, Surrey.

Healix Health Services Ltd is a healthcare company providing medical advisory and case management services within the UK. Due to new business, our expanding workload, and a change in our working practices, we have an opportunity within Healix Health Services for Medical Claims Advisors.

The Role

Working in liaison with the Health Services team of Medical Case Managers and reporting to the Claims Manager, Medical Claims Advisors will support the Medical Case Managers in the provision of a professional and high standard of customer service at all times.

Responsibilities

  • Support medical case managers with claim handling from member referral through to discharge, including issuing pre-authorisation of eligible claims
  • Answer incoming calls quickly and within agreed service standards, providing a high level of customer service at all times
  • Deal with provider queries or requests in relation to clinical treatment or pre-authorisation requests
  • Process invoices received in-line with agreed service standards, member benefit limits and policy terms and conditions
  • Issue pre-authorisations in line with agreed authority levels, with escalation to the relevant Case Manager where appropriate.
  • Assist Medical Case Managers in the management of ongoing or high costs claims
  • Manage Claims administration reminders and outstanding actions
  • Assess invoices received to ensure costs are in line with provider contract terms
  • Adhere to all internal processes and procedures at all times
  • Maintain and document accurate records on our Case Management System to include: all invoice or claim related payments, and all communication with members and providers
  • Audit all provider invoices in line with Healix reasonable & customary rates (where appropriate)
  • Escalate any complaints or call backs in a timely manner
  • Communicate directly with members, clients, providers and other members of the Healix Group of Companies as required.

The Hours  The Medical Claims Advisors will be required to work Monday to Friday, 35 hours per week, between the hours of 8am to 6pm.

Relevant Skills  Medical Claims Advisors are required to have or develop all the following areas of expertise:

  • Strong customer focus with excellent  verbal and written communication skills
  • A positive, helpful attitude and willingness to work co-operatively with other members of the team
  • Previous experience of the 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
  • Highly adaptable, with a flexible approach to work, and be willing to do what is required to ensure that the team achieves its objectives while remaining focused on quality
  • A pro-active 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
  • To demonstrate exceptional customer service within the department and in-line with our servcie expectations and goals.

All team members will be monitored for level of efficiency, accuracy and customer satisfaction.  

Full training will be provided. 

Interested? Please send or email your CV with a covering letter, quoting Ref: HHSMCA, to:

Human Resources Department,
Healix Group of Companies,
Healix House, Esher Green,
Esher, Surrey. KT10 8AB.

Email: careers@healix.com