Summary
Date Posted: Thursday, September 02, 2021 , Base Salary: Not Disclosed

JOB DETAILS:
Job title: Medical Advisor 21000518
Our Health and Benefits business helps large and mid-size clients control health and welfare plan costs, improve health outcomes and promote employee engagement through broad-based, state-of-the-art interventions. We provide solutions encompassing creative plan design, vendor evaluation and management, pricing and funding strategies, data analytics, valuation support, compliance and governance strategies. We also provide Specialty consulting services including clinical/health management program design, pharmacy solutions, disability/absence management strategies and claims audit services.
As a Medical Advisor dedicated to Care and Case Management you will consult and manage clients’ liaison with insurance companies on a wide variety of projects including reviewing and negotiating bills, advising on the best care options, developing wellness strategies, managing a help line, overseeing the claims function and delivering on Service Level Agreements (SLAs) for Health and Benefits programs including medical, dental, life and disability. You will serve as the lead for day to day communication liaison with our clients as regards claims and care issues and participate in the creation of new intellectual capital.

The Role
As a Medical Advisor in our office in Kampala you will have the following responsibilities:
• Provide valued-added consulting expertise on projects including health and welfare plan re-design, pricing, funding and employee contributions strategies, benchmarking studies and negotiations, plan renewals and vendor analysis and management
• Contribute to projects within the Specialty area including health management, disability management, pharmacy and claims audits
• Contribute to the development of new tools and approaches
Care & Case Management
• Visit admitted selected patients in hospital to ensure they are receiving treatment in line with policy and agreed Service Levels
• Sample and audit hospital bills to ensure accuracy and prepare written evaluation of them
• Provide client case management reports to determine how scheme covers can be improved / modified in order to suit the clients' needs better
• Ensuring that hospitals send pre-authorization requests to insurers in line with agreed SLA timescales
• Ensure timely authorization of such requests by insurers
Health Talks / Wellness Days
• Facilitate communication of topical medical information to clients through regular health bulletins or Group meetings
• Facilitating training sessions on health matters
• Preparing proposals for Wellness days
• Coordinating different suppliers during wellness days to ensure objectives of the day are met to the satisfaction of the client
• Preparing reports for Wellness days carried out for WTW clients
Claims Services
• Oversee and liaise with operations team on receiving, documenting and following up on reimbursement claims to ensure that clients get reimbursed within the stipulated Turn Around Times
• Oversee verification of claim documentation to ensure completeness and coordinate with operations personnel to ensure these are forwarded to insurers or seek additional information from the client.
• Provide medical perspective on claims reports prepared by WTW analysts, participate in client and Sales meetings to articulate these perspectives
Service Providers
• Conduct hospital visits during which you will ensure service providers have updated schedules and scheme rules of all WTW schemes
• Ensure that service providers have adequate supply of claim and pre-authorization forms / functioning authorization ports.
• Provide information to all stakeholders on new developments at service providers, including but not limited to revision in consultation fees, bed charges; suspension from insurers’ panel and new equipment available at these hospitals
• Man a help line and ensure that calls that require a Medical Consultant are dealt with promptly, logging cases and resolution provided.
• Advise all stakeholders on emerging treatment / health management protocol
• Negotiating with non-panel service providers in order for our clients to get the best service at a fair price
• Liaising with insurers to include our clients' preferred service providers to the panel
• Sample functionality of access cards through various effective strategies
• Coordinate Evacuations and access to second opinions as may be required by clients.
• Ensure our clients have accurate Member Guides with claims procedures


The Requirements
• 3+ years’ experience and experience working in insurance / corporate and hospital environments
• Success in the design/management of health and welfare plans gained in a consulting, brokerage or carrier environment
• Strong Care and Case management skills; prior experience in health and welfare roles preferred
• Proven experience successfully managing wide client portfolios simultaneously and producing quality deliverables on time and within stipulated timelines
• Demonstrated success in managing client issues and relationships; some experience in growing relationships with current clients
• Strong interpersonal and team skills
• Polished and well developed oral and written communication skills in English
• Flexibility and proven ability to diagnose and resolve issues
• Ability to Interact with all levels of medical and administrative staff
• Experience training/mentoring junior staff
• The ability to see the "big picture," leveraging the resources of related practices to address the clients' Wellness challenges
• Working knowledge of Excel, MS Project, MS Word
• Availability to travel on an as needed basis
• Applicant must be a Registered Nurse; Bachelor’s degree is preferred
We are committed to equal employment opportunities at Willis Towers Watson

Education Requirement: No Requirements

Job Experience: No Requirements

Work Hours: 8

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