Medical Consultant (Assistant Manager)

The role

As a Health and Benefits Consultant 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 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.

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 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 preauthorization 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 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

Excellence

• Develop A Broad Understanding of the Health and Benefits Space and WTW’s Key Differentiators Providing Valued-Added Consulting Expertise on Large, Sophisticated Projects Including Health and Welfare Plan Re-Design, Pricing, Retiree Medical Valuations, Funding and Employee Contributions Strategies, Reserve Calculations, Benchmarking Studies and Negotiations, Plan Renewals and Vendor Analysis And Management

• Ability To Articulate in Meetings, In Written Communications and In Formal Presentations, The Overall Willis Towers Watson Proposition and Specifically the Features and Benefits of Our Products and Services.

• 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

People

• Build relationships internally and collaborate effectively on cross-functional teams

• Demonstrate natural ease and effectiveness when dealing with clients/colleagues at all levels

• Serve as mentor to Consultants and Senior Consultants al opportunity employer.

The Requirements

• Minimum of 6+ years’ experience in Health & Benefits consulting, clinical case management, or health insurance operations within a consulting, brokerage, insurer, or healthcare provider environment.

• Bachelor’s Degree, experience in insurance broking will be an added advantage

• Strong consulting and client management capability, with demonstrable experience advising clients on healthcare delivery, claims trends, benefit design, and care optimization strategies. Exposure to healthcare pricing, underwriting, or actuarial valuation is an added advantage

• Relevant clinical or medical background Nursing (or equivalent healthcare qualification) with practical experience in patient care, utilization review, or case management.

• Demonstrated track record in managing complex client issues, including escalation handling, claims disputes, provider negotiations, and stakeholder engagement, while maintaining strong client relationships.

• Strong Interpersonal And Team Skills

• Polished And Well-Developed Oral and Written Communication Skills

• Self-Starter Attitude And Ability to Work with Ambiguity

• Flexibility And Proven Ability to Diagnose And Resolve Issues

• Strong Analytical and Creative Skills

• Experience In African Regional Health Insurance Policies Preferred

• Working Knowledge Of Microsoft Office