Location: Tewkesbury/hybrid
Hours: Full Time
Salary: £24-27k
Purpose of the role
To provide an effortless journey for all members making claims via their company Healthcare Plan while always adhering to the respective Rules & Benefits.
Principle objectives and responsibilities include the following, other objectives may be assigned:
Key Responsibilities
- Establish the current reason for ill health/injury and identify any underlying
cause or contributory risk factors - To be instrumental in the multidisciplinary assessment process by ensuring information is gained sufficient to assess personal and occupational risk factors
- To effectively communicate to the member, the multifactorial issues associated with the current episode of ill health/injury and how they can personally address the risk factors within their control
- To follow managed care pathways, NICE and evidence-based guidelines
- Where appropriate review both private and NHS options when making onward referrals for consultations, investigations and treatment
- Demonstrate a clear understanding of the Rules & Benefits for each individual plan and keep up to date with any changes/amendments made to these policies
- Source appropriate treatment providers whilst always adhering to guidelines outlined in the Rules & Benefits
- Always manage claims within the restraints of the Rules & Benefits
- Ensure any escalations are managed using the appropriate processes and guidelines
- Ensure that all information is accurately recorded in CRM
- Meet all legal compliance requirements and healthcare rm quality assurance standards
- Demonstrate a professional and respectful approach during all interactions whether this be internal or external
- To ensure that costs are managed to ensure they are fair and appropriate
and no greater than regional averages - To work seamlessly with the onsite Functional Health Team to both take referrals and to provide tasks for them to add a three-dimensional approach to the case but specifically to review objective measurements where appropriate
- To maintain knowledge on ALL aspects of integrated health risk
management - To take responsibility for recognition of any training needs in discussion with
your Line Manager - Take accountability for any errors including DPA breaches via prompt reporting to your Line Manager or other Senior Manager
- Demonstrate team work ethos
- Demonstrate entrepreneurial flair and best in class innovation
- To undertake any other task as may reasonably be required by the company
- Develop and sustain relationships with both internal and external customers. Remembering you are the face and voice of healthcare rm
Skills knowledge & expertise
- Ability to use Microsoft office including Word, Teams, Excel, Outlook and PowerPoint
- Demonstrate confident telephone skills using effective listening and empathy with employees and stakeholders, covering both inbound and outbound calls
- Adopt an investigatory approach to cases and to ensure that all obstacles are identified and removed where necessary and or appropriate
- Demonstrates analytical and problem-solving skills
- Ability to be able to work confidently with little supervision but at the same time be able to recognise when to seek help, support or clarification
- Ability to understand the impact of work on an individual and the impact of ill health on an individual’s ability to work.
- Plans and controls activities to meet objectives
- Maintains productive working relationships
- Manage workload effectively to meet customer deadlines and service standards
- Demonstrate knowledge and adherence to healthcare rm’s performance and procedures standards.
- Clinical and non-clinical care pathways
- Understands and demonstrates GDPR, DPA & ICO rules and guidelines relating to customers
- General occupational health and legal principles.
- The fundamentals of the healthcare rm functional health practises
- How to effectively manage an integrated health approach to the prevention and management of workplace ill health/injury
- How to conduct telephone assessments and feedback using motivational interviewing or similar techniques.
- CBT principles and motivational interviewing techniques are also a valuable skill for this role
Qualifications & Experience – Ideal
- Qualified: physiotherapist, corrective exercise professional, counsellor, CBT practitioner, nutritionist, physiologist, nurse or other appropriately qualified professional.
- HR, Sport & Exercise professional or other similar professional.
Qualifications & Experience – Minimum
- English and Maths GCSE Grade C or above.
- Degree level education or Equivalent professional certification or extensive relevant experience.
- Need to evidence ability to write clear and accurate English.
All successful candidates will be subject to DBS checks.
HCML is committed to equality of opportunity for all staff and applications from individuals are encouraged regardless of age, disability, sex, gender reassignment, sexual orientation, pregnancy and maternity, race, religion or belief and marriage and civil partnerships.