Healthcare Claims Case Manager

Job Title: Healthcare Claims Case Manager

Reports to: Case Manager Team Leader

Department/Area: Claims

Location: Letchworth

Broad Band: C

JOB PURPOSE

To provide, both personally and through guiding others, the complete clinical and financial management and control of higher value/complex PMI Healthcare claims in the most cost effective way, achieving customer service and productivity standards, embracing agreed best practice and regulatory requirements. To assist the cost-effective control and management of Healthcare claims suppliers on a case-by-case basis in line with Claims strategy.

KEY RESPONSIBILITIES

Controlling your own portfolio of claims to the highest level of technical competence while adhering to Best Practice for all aspects of technical claims handling.
Settling claims and operating within personal authority level set and highlighting relevant issues eg significant potential/reserve increases etc to your line manager.
Adhering to the quality standards set by Senior Management and feeding back any issues which may contribute to the development of such standards.
Delivering high standards of productivity and customer service, in line with agreed standards, while adhering to stated best practice.
Acting as a referral point, developing and maintaining medical training materials and providing training, guidance and support on all clinical/medical matters to staff at any level.
Undertaking liaison with medical professionals and service providers as required in the course of claims handling, representing Groupama on appropriate external committees, highlighting issues or areas of concern relating to providers or individual cases and working with internal or external parties to address them.
Staying abreast of, and assessing the impact of changes in, medical/surgical developments and treatments on Healthcare claims and reporting concerns and/or suggested improvements to your line manager in order that Best Practice procedures are developed to reflect such changes.
Assisting the cost-effective management of external suppliers on a case-by-case basis by staying abreast of medical/surgical developments, creating case management plans, negotiating rates and providing any required information to the Technical Claims Compliance & Procurement Controller.
Any other ad hoc duties within your capabilities that are relevant to the job and reasonably requested of you by your manager.

Dimensions

Direct reports	N/A.
Overall staff under control	N/A.
Budget authority	No.
Claims handling/settlement authority	Refer to individual Claims Authority Document.
Claims cheque inputting/authorisation authority	Refer to individual Claims Authority Document.
Authorisation authority (ordering/invoices)	N/A.
Key internal contacts	Claims staff at all levels within own location. Underwriters. Technical Claims Compliance & Procurement Controller.
Key external contacts	Hospitals/Hospital Groups, CMO, Consultants.
Any other dimensions	Provides technical medical/clinical guidance to whole PMI Healthcare Claims function. Chairs Medical Liaison Committee.
This Job Description is provided as a guide only and is not contractual

How to Apply

We are committed to the principle of equal opportunity in employment. The Company is opposed to any form of less favourable treatment, whether through unfair, inconsistent direct or indirect discrimination, accorded to employees and applicants for employment on the grounds of sex, sexual orientation, marital or parental status, disability, race, religion or belief, age, creed, colour, nationality, ethnic or national origin.

Having a criminal record will not necessarily bar you from working with us. This will depend on the nature of the position and the circumstances and background of the offence.