Customer Services Executive

Posted 14 March by Healix Easy Apply

Customer Services Executive

Healix Health Services

Windsor House, Esher

35 per week worked Monday to Friday, plus one half day Saturday per month

Key activities of a Medical Claims Assessor

  • To represent the client and/or Healix 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
  • Deal with provider queries in relation to clinical treatment or pre-authorisation requests
  • Arranging care with the appropriate medical team/facility
  • Ensuring treatment delivered is relevant and appropriate by monitoring ongoing treatment plans for members
  • Negotiating provider fees to within the Healix Reasonable and Customary fees, as part of cost containment for clients
  • Pro-actively communicating with all parties providing relevant information to:
  • Our clients
  • The treating medical team
  • Members of the Healix team
  • Escalating any complaints in a timely manner to your direct line manager
  • Responsible for managing reminders and any outstanding actions
  • Adhere to all internal processes and procedures at all times
  • Providing feedback, and assisting in the development of standard operating procedures and protocols
  • Assisting the Medical Case Managers with high cost claims where required
  • 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 Healix Group
  • Obtain medical evidence from providers to substantiate claims decision/treatment
  • Ensure all documents are correctly allocated on Case Management System
  • Maintain accurate and contemporaneous record keeping

Requirements of a Medical Claims Assessor

We are looking for an individual with the following areas of expertise:

  • Proactive in keeping up to date on all our clients’ requirements and able to locate and interpret all relevant policy documentation
  • High standard of customer service and ability to demonstrate customer led thinking
  • Decision making skills and ability to use own initiative
  • A diplomatic open style and approach, with excellent verbal and written communication
  • A high degree of accuracy and attention to detail
  • Experience working in a call centre environment is desirable
  • 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 plan and organise own workload as well as work well under pressure
  • The ability to work well both independently and as part of a team

Additional Requirements of a Medical Claims Assessor

  • 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

Main Purpose of a Medical Claims Assessor

Working in liaison with the Health Services team and reporting to the Operations Manager, Medical Claims Assessors will be required to provide a professional and high standard of customer service at all times.

The Medical Claims Assessors will co-ordinate the patient’s treatment plan; liaising 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.

Additional

The Medical Claims Assessor will be required to work a 35 hour week, Monday to Friday covering 8am to 6pm and Saturday mornings from 8am to 1pm. We operate a shift pattern Monday to Friday, shifts are 8am to 4pm, 9am to 5pm and 10am to 6pm. Individuals are required to work 1 Saturday per month for which overtime is paid.

Team members will be monitored for levels of efficiency, accuracy and customer satisfaction.

Full training will be provided.

To apply please forward your CV and covering letter to us

Reference: 34685254

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