• Take initial calls from policyholders in relation to medical claims or enquiries:

• Establish the purpose of the call and determine the salient points in a timely fashion without exploring unnecessary avenues
• Establish whether the caller has a valid policy in place using all available resources
• Document the facts of the case on the Case Management System (CMS)
• Provide advice on the documentation required to proceed with a claim
• Provide clinical leadership and guidance to the team to ensure members receive timely and accurate cover decisions, allowing them to progress with their treatment.
• Arrange care with an appropriate medical team/medical facility utilizing company network providers wherever possible
• Assess any proposed treatment plans for medical necessity and to ensure they fall within policy terms and conditions
• Ensure that treatment delivered is appropriate at all times by monitoring ongoing treatment plans and medical updates for individuals.
• Monitor patient progress and liaise with the provider to ensure the member is discharged to an appropriate environment.
• Liaising with treating medical staff, providers and with medical staff in order to manage cases efficiently and ensure the very best care plan is established for patients.
• Maintain accurate case records on the CMS system to include details of care delivered and all related communication.
• Make sure that treatment received and delivered meets policy requirements and standardization.
• Communicate effectively with all parties providing relevant information to:

• Clients and treating medical team
• Members of the team
• Patients and their families.
• Ensure that costs remain routine and customary for the care delivered.
• Medically audit provider invoices where necessary.

• Preferred to have at least 5 years of nursing experience, with at least 1 year in A&E Department
• Can do call centre duties
• Can access the patient's condition on the first level
• Able to communicate fluently with Japanese callers

Learn more...