Claims Advisor
Title:
Claims AdvisorType:
PermanentStart Date:
ASAPSkills:
Essential:
- English Language & Mathematics GCSE/O level standard (or equivalent)
- Biology, Health studies qualification, or Medical terminology
- Good knowledge of MS Word and Excel, together with experience of using in-house databases.
Desirable:
- CII qualification (or equivalent)
- Experience of working within the insurance area, ideally Private Medical Insurance
- Experience of working from policy documents and procedure manuals
- Experience of dealing with elderly customers and/or people in poor health
- Good understanding of regulatory requirements (FCA and ICOB)
Skills & Abilities
- Excellent verbal and written communication skills
- Ability to show empathy and sympathy
- Professionalism and assertiveness to apply rules and procedures whilst retaining customer satisfaction
- Ability to communicate with people at all levels
- Ability to show initiative and make decisions
Personal Attributes
- Effective team worker
- Organised and timely with the ability to prioritise and multitask
- Interest in working in the insurance industry
- Dedication to excellent customer service & standards
- Willingness to undertake training & progress knowledge
- Willingness to work towards a CII qualification (desirable)
Description:
This role is Monday to Friday offering flexibility in hours, 8am – 4pm OR 9am – 5pm OR 10am – 6pm. Probably the best benefits package in Surrey!!!!
An exciting opportunity to join an award winning specialist private health insurance provider. The purpose of this role is working and providing members with a professional and timely claims handling service, in accordance with policy terms and conditions. The successful candidate will demonstrate dedication to excellent customer service & standards.
Key Elements
- To manage all incoming customer communications, providing a high level of customer service;
- To provide advice on policy terms and conditions;
- To assess provider invoices and be a expert processor for one of the main hospital groups acting as account liaison adviser;
- To support other team members through assisting them with policy-related and clinical queries or concerns.
Key Responsibilities
- Professional and prompt handling of incoming customer calls;
- Pre-authorisation of possible high value eligible claims highlighting important areas such as benefit limits, excesses and co-payments, eligible hospitals and the process to be followed during the claim;
- Establish treatment costs in advance, highlighting benefit shortfalls and considering opportunities for cost reduction.
- Utilise medical advice and CMO services as appropriate;
- Handle queries providers in relation to the clinical treatment of members;
- Provide members with written pre-authorisation for eligible out-patient diagnostic treatment;
- Accurate and consistent assessment of new and on-going claims taking into account policy terms and conditions;
- Prompt and accurate written pre-authorisation of claims;
- Thorough and accurate assessment of incoming invoices from treatment providers
- Act as point of contact for affinity partners
