Medical Claims Consultant
Salary: £Competitive + Bonus + Benefits
Closing Date: Monday 30 September 2019
Department: Clinical Risk
Vitality is an award winning, dynamic and vibrant financial services provider, with a ground-breaking vision for the future, where individuals are enabled to succeed and are rewarded and recognised for their contribution to our business.
Our CORE PURPOSE is to make people healthier and to enhance and protect their lives. From people to products and processes, we aspire to deliver on our purpose in everything we do.
Our VISION is to be the BEST health insurer in the UK
We are looking for talented individuals who are committed to living our values and delivering an award winning service to our customers.
Overall Job Purpose
To assist in the protection and control of the claims fund by identifying, monitoring and, where necessary, correcting claim, system coding and invoicing issues that may adversely affect the fund
To provide guidance and training to HAs/UW and other business areas e.g. the Vitality GP services where this will help to protect the claims fund and ensures customer treated fairly.
* To challenge and promote changes to processes and procedures where these may have or cause a risk to the claims fund
* Constructing and suggesting improvements to claims guidelines
* To prepare and deliver subject specific training in areas of claims, UW and other business areas as required
* Act as a subject matter expert in all areas of claims management, working closely with L&D to enhance the clinical/ technical competencies of customer facing HAs
* To assist in the maintenance the claims/UW guidelines & stances by developing/updating new claim stances & UW material
* To support VitalityCare in the auditing of the high value invoices
* To act as a subject matter expert for VitalityCare specialist enquiries
* To identify and raise for discussion clinical developments which may impact the claims fund
* Excellent knowledge of company systems and corporate structures
* Ideally will have experience as senior claims or telephone claims assessor or equivalent internal or external experience
* Knowledge of legislation and regulation, including Data Protection, Access to Medical Records, and FCA rules and guidance
* Excellent knowledge of PMI products, in-depth knowledge of Vitality Health's processes across all product and work-types
* Excellent understanding of medical conditions
* Of training in 1:1 situations and larger groups
* Up to date knowledge of current clinical issues impacting PMI.
* Excellent written and verbal skills, including competence in gathering data and presentation of information
* Good communication skills and confidence to challenge existing processes and procedures and implement changes
* Ability to deliver high quality training, mentoring and guidance both verbally and in writing
* Able to work independently and as part of a team
* Creative, innovative and good problem solving skills
* Ability to influence decisions within their peer group and the wider business
* Clinical qualification or equivalent
* Extensive claims experience
Working for Vitality, you'll experience an exciting mix of creativity and innovation, within a framework of challenging objectives and a passion for delivering the best. We think work should be fun and sociable, and we want our people to get the most out of every day.