2 months ago
We are recruiting for an International Private Medical Insurance Pre-authorisation Administrator
Our client is a dynamic and expanding company with contemporary offices in Cardiff Bay, overlooking Roath Basin. Their private roof terrace is an enviable suntrap in the summer months for the team who regularly socialise together outside of work.
They have built a reputation within the industry as a company who looks after their staff, delivering excellent training and career progression. In fact, many of their employees have been with them for more than 10 years.
As their new and existing departments sustainably grow, they are now recruiting to serve a new venture in the company’s portfolio and to cover the busy Summer season that is fast approaching.
They also encourage language speakers to apply particularly those speaking German, Spanish, French, Japanese, Mandarin or Cantonese.
The IPMI Pre-authorisation Administrator is to work alongside the 24 hour assistance, medical teams and claims department in providing support to clients with international private medical insurance claims. The IPMI Pre-authorisation Administrators’ role will assist with the management of pre-authorisation requests and reserving of benefits for both members and providers. Additionally, the Pre-authorisation Administrator will be required to assist with explanation of benefits and cover decisions, and when required the assisting with claims queries.
The IPMI Pre-authorisation Administrator will ensure that pre-authorisations requests are processed efficiently within the policy terms and conditions. They will determine insurance coverage and benefit available as well as investigate and resolve queries on new and previously approved pre-authorisations. You will be required to interact with insured members, medical providers, underwriters and other third parties. You will need to maintain quality standards and ensure outcomes are compliant with policy terms and conditions and handled within regulatory requirements.
The IPMI Pre-authorisation Administrator will be responsible for providing accurate and complete data input for pre-authorisations and for providing excellent customer service.
You will be required to work a 35 hour week, worked between the hours of 8am and 8pm, Monday to Friday. The department operates two main shift patterns (8am-4pm or 12noon : 8pm)
There may be an occasional requirement to work outside of these hours in order to assist with shift cover, but this will be done on an ad hoc basis and discussed in advance.
Duties and Responsibilities:
• To represent the company and client in a professional manner at all times.
• Answer calls from providers, hospitals and patients.
• To take calls from members in relation to initial and/or ongoing claims, general scheme queries and to give benefit explanations where required.
• Answer incoming calls promptly and within SLAs, providing the highest level of customer service at all times.
• Responsible for managing own pre-authorisation tasks and any outstanding actions and overall productivity within SLAs.
• Adhere to all internal processes and procedures at all times.
• Monitoring and updating ongoing treatment plans and costs for members with input from the assistance and medical teams.
• Pro-actively communicating with all parties providing relevant information to:- Clients and their members/policyholders- The treating medical team- Members of the team
• Ensuring that treatment received and delivered meets policy requirements and standardisation.
• Investigating, managing and escalating complaints in a timely manner to a Department Manager or direct line manager, ensuring company adherence to all regulatory requirements.
• Providing feedback, and assisting in the development of standard operating procedures and protocols.
• Accurately enter required information into computer database.
• Call back providers and member with pre authorisation numbers and explanation of coverage when needed, and providing Guarantees of Payment for authorised treatments with a copy sent to all relevant parties.
• Follow up on patients in hospital and confirm discharge dates as needed or request the additional information if extended admission required.
• Maintain patient confidentiality as defined by regulatory bodies.
• Maintain cooperative working relationships with all relevant departments.
• Referring claims for notification and authorisation to the Underwriters.
• Further tasks deemed appropriate by your line manager and/or the Management Team.
Knowledge, Skills and Abilities:
• A high degree of accuracy and attention to detail.
• The ability to work well both independently and as part of a team.
• The ability to follow processes and efficiently collect data in a friendly and professional manner.
• Excellent written and verbal communication skills, as all correspondence is remote and a large number of insured are not English mother-tongue.
• A calm, diplomatic, open and professional approach, with the ability to handle enquiries from all parties, VIPs, insured personnel and Underwriters alike.
• PC skills with a good knowledge of Microsoft packages, ideally with advanced knowledge of MS Excel, Word and PowerPoint.
• Be able to demonstrate exceptional customer service in-line with service expectations and goals.
• Experience of working within a healthcare setting, handling travel, medical or personal accident claims.
• Experience of private medical insurance or international private medical insurance would be an advantage.
• Experience of managing claim reserves.
• Previous experience of handling PMI/IPMI pre authorisation requests.
• Language skills would be advantageous, in particular German, Spanish, French, Japanese, Mandarin or Cantonese.
To apply for this administrator role, please submit your current CV and contact details online.
Orange Recruitment is advertising this position on behalf of our client. By clicking apply you accept that your application will be forwarded to only this client in order for them to consider you for the role.
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