HCML
Healthcare Plan Case Manager (Corporate Healthcare)
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Healthcare Plan Case Manager (Corporate Healthcare)
Healthcare Plan Case Manager
Job Title
[Healthcare Plan Case Manager](Healthcare Plan Case Manager)
Location
Tewkesbury (Hybrid)
Salary
£26,500 to £27,500 per annum
Status
Permanent
Working Hours
Mon – Fri, office hours: 8am to 6pm Rota Schedule:
- 3-week cycle
- 8:00am to 4:30pm (Early)
- 9:30am to 6:00pm (Late)
- Flexi Week
About the Role
HCML is the UK’s leading provider of rehabilitation, case management, occupational health, and workplace wellbeing services. Recognised as a 2025 UK’s Best Workplace for Wellbeing, we foster a culture where the growth, development, and wellbeing of our staff are prioritised.
We are seeking a Healthcare Plan Case Manager to join our Healthcare Plan team, where you will deliver an exceptional customer-focused experience. This role involves guiding individuals through their healthcare journey, applying expert knowledge to manage cases with precision, and ensuring compliance with clinical best practices and plan rules. Working in a fast-paced, collaborative environment, you will blend empathy with analytical decision-making to meaningfully improve health and wellbeing, while maintaining the highest standards of service quality and compliance.
Purpose of the Role
To uphold a seamless Healthcare Plan experience for all members making claims, while strictly adhering to rules and benefits policies. The Healthcare Plan Case Manager will act as a trusted adviser, balancing empathy with professional expertise. Your responsibilities include:
- Empowering members to understand their condition and available healthcare options.
- Helping them engage in their recovery journeys, including applying plan-specific rules and benefits.
- Managing costs responsibly to ensure fair and compliant decisions.
- Ensuring all decisions are transparent, evidence-based, and aligned with regulatory and clinical standards.
Key Responsibilities
- Establish the reason for ill health/injury, identifying any underlying causes or contributory risk factors.
- Play a multidisciplinary role by ensuring sufficient information is gathered to assess personal and occupational risk factors.
- Clearly communicate multifaceted health issues related to the current episode to members, highlighting actionable risk factors.
- Follow managed care pathways, NICE guidelines, and evidence-based practices.
- Review both private and NHS options where appropriate, making informed onward referrals for consultations, investigations, and treatment.
- Demonstrate a practical understanding of Rules & Benefits for each individual plan, keeping up to date with policy changes or amendments.
- Source appropriate treatment providers while adhering to guidelines.
- Manage claims within the framework of the Rules & Benefits, ensuring compliance and accuracy.
- Escalate issues using established processes and guidelines.
- Accurately record all information in the CRM system.
- Ensure legal compliance and healthcare quality assurance standards are met.
- Maintain professional respectfulness in both internal and external interactions.
- Balance cost control so expenditures remain fair, reasonable, and competitive with regional averages.
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Collaborate with the Functional Health Team, absorbing referrals, and providing feedback to develop a holistic case management approach, especially with a focus on objective measurements.
- Maintain knowledge across integrated health risk management.
- Proactively raise training needs, engaging with your Line Manager for development opportunities.
- Take full accountability for errors, including those related to data protection (DPA breaches), by reporting promptly to senior management.
Additional Duties
- Cultivate and sustain strong relationships with internal and external customers.
- Demonstrate innovation and entrepreneurial spirit.
- Undertake any other tasks deemed necessary by the organisation.
Metrics of Success:
- Monitoring call audit summaries, reports, and system entries.
- Evaluation of Continuing Professional Development (CPD) efforts.
- Performance reviews against sought-after outcomes.
Person Specification
Experience
Essential
- Good IT knowledge.
- Experience in managing workloads to meet customer deadlines and service standards.
- Ability to work with minimal supervision while recognising when external support is needed.
- Established track record in maintaining positive working relationships.
Desirable
- Experience in claims management.
Skills & Knowledge
Essential
- Computer literacy: Proficient use of Microsoft Office (Word, Teams, Excel, Outlook, PowerPoint).
- Confident telephone skills, including effective listening, empathy in inbound and outbound calls.
- Strong analytical and problem-solving abilities.
- Capacity for inquisitive, obstacle-removing brainwork.
- Ability to understand the impact of ill health on liveliness/work.
- Robust planning and organisational skills to execute objectives efficiently.
Desirable
- Understanding of clinical and non-clinical care pathways.
- Familiarity with GDPR, DPA, and ICO guidelines.
- Knowledge of occupational health and relevant legal principles.
- Aptitude at tackling workplace ill-health/injury management.
- Skillset in conducting telephone assessments using motivational interviewing techniques or similar.
- Awareness of organisational performance standards and policies.
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Attributes
- Display empathy, and strong interpersonal skills.
- Exhibit self-motivation to work independently.
- Attain a proactive, investigative mindset.
- Possess attention to detail in all interactions.
- Intrinsically resilient, balancing competitive priorities.
- Deliver a professional, customer-centric approach.
Qualifications and Training
Essential
- Demonstrated proficiency in English and Maths at GCSE Grade C (or equivalent).
Desirable
- Degree-level education or equivalent professional certification.
Company Benefits
Health & Wellbeing
- Medicash Health Cash Plan: Access to reimbursement for dental, optical, and chiropody services, with free dependent coverage for children. Plus, enjoy 24/7 Digital Health, comprising:
- Virtual GP helpline.
- Employee Assistance Programme (EAP).
- Mental Health Support: Up to 8 fully funded sessions of face-to-face counselling or CBT.
Financial & Retirement Support
- Pension Scheme & Pension Salary Sacrifice options.
- Death in Service Life Cover: A benefit equal to 4x your base salary.
Philanthropy & Work-Life Balance
- Payroll Giving: Support favourite causes directly from gross pay.
- Annual Leave: 25 days + bank holidays, plus Birthday Leave.
- Holiday Flexibility: Option to buy or sell up to 3 days/year as required.
Volunteering & Development
- Giving Back: Up to 2 fully paid Volunteering/Community days annually.
- Comprehensive Maternity and Paternity policies, alongside generous Company Sick Pay.
Professional Growth
- Professional Subscriptions & Certifications: Funding for post-probation.
- Opportunities for internal promotions and secondments.
Recognition & Engagement
- Annual pay reviews and organisation-wide exclusive employee awards.
- Request features for diverse social and professional events.
Equal Opportunities Statement
HCML is committed to equality of opportunity and encourages applications from all individuals regardless of age, disability, sex, gender reassignment, sexual orientation, pregnancy, maternity, race, religion or belief, or marriage and civil partnership. We value diversity and seek to foster an inclusive, supportive workplace for all.
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