医疗保健公司寻求: 案例管理助理(中文为优势)

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坐标:Farnborough

公司:Aetna

职位:Case Management Associate

性质:Permanent, Full-time

申请方式:阅读原文,点击链接申请。(如果链接打不开,请联系小编哟)



Job Description

Medical Assistance Team is a global team supporting our international members. The continued success and growth of the business has led to a number of newly created roles in this team. This is an excellent opportunity for someone with fluent language skills ideally in a customer focused role to join this exciting busy team. Key languages we are seeking are German, Italian and French though we also welcome those with fluent Mandarin, Russian and Turkish. These are shift based roles working 4 days on and 4 days off.



Family Summary / Mission

Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations. 



Position Summary / Mission
  • Working night shifts on a 4 days on / 4 days off rotating basis, you will take responsibility for looking after our members across the globe

  • This position demands a high level or responsibility and you will work with a good degree of autonomy in a challenging yet highly rewarding environment

  • You will provide operational and logistical support to our Clinical Case Managers, working in partnership to coordinate the delivery of medical evacuation and health careservices

  • You will rapidly investigate, review and adjudicate claims, taking a proactive, highly professional and customer centered approach



Fundamental Components & Physical Requirements

  • Working within the Member Assistance 24x7x365 contact center, investigate, consider and pre-authorise healthcare claims globally

  • Professionally manage inbound and outbound telephone, fax and email correspondence with customers, brokers, suppliers and all other interested parties ensuring that appropriate and timely communication is maintained at all times

  • Complete eligibility verification, escalate medical information to Clinical Case Managers, determine coverage, identify discrepancies, and apply all cost containment measures including identification of opportunities for subrogation and recovery

  • Triage and prioritise caseload considering urgency, geographical location, service required, customer expectations

  • Take ownership for progression of own caseload, maintain communication, remove barriers, avoid delays

  • Coordinate outpatient care, inpatient hospital admissions and emergency evacuations

  • Identify, control and escalate high cost claims

  • Investigate claims for possible abuse and fraud. May facilitate training and coaching when considered topic subject matter expert

  • Escalate unresolved claims, complaints and high costs claims to Service Delivery Leader for guidance

  • Continually work to improve best practices, procedures and standards

  • Ensure compliance with requirements of regional compliance authority / industry regulator

  • Adheres to international privacy policies, practices and procedures

  • Strives to deliver consistently excellent customer service internally and externally



Background / Experience Desired

  • Previous experience in a clinical role or medical assistance environment highly desirable

  • Proven telephone customer service experience

  • Experience within health insurance industry would be beneficial



Educational Requirements

  • Educated to minimum A-Level standard (or equivalent level of experience) 

  • Second language or previous clinical qualification / experience 



Additional Information (not mandatory to complete)

  • Working knowledge of Word, Excel, Email and Internet

  • Competent typist Excellent customer service skills with a strong command of written and spoken English

  • Good communicator with strong organisational and problem solving skills

  • Shifts which operate between 7:30pm – 8.30am on a 4 days on / 4 days off rotating shift basis. Our team operates 24hrs a day, 7 days a week, 365 days a year and therefore candidates should be prepared to work some bank holidays according to the shift rotation (appropriate compensation is provided)





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