Medical Consultant – Care & Case Management Manager

About the role

The Medical Consultant (Manager) will lead health and benefits consulting for Care and Case Management, acting as the primary liaison between clients and insurers. You will oversee claims, wellness initiatives, and service‑provider relationships while ensuring compliance with service level agreements.

Key responsibilities

• Visit admitted patients in hospitals to verify treatment aligns with policy and SLA requirements.
• Audit and evaluate hospital bills, preparing written reports and recommendations.
• Produce client case‑management reports to optimise scheme coverage.
• Manage pre‑authorization requests, ensuring timely insurer approvals.
• Facilitate health talks, wellness days, and training sessions for clients.
• Coordinate suppliers for wellness events and compile post‑event reports.
• Oversee claims processing, verify documentation completeness, and liaise with operations to meet turnaround times.
• Provide medical insight on claims analyses and participate in client and sales meetings.
• Conduct hospital visits to update service‑provider schedules, forms, and equipment information.
• Operate a help line, logging cases and delivering prompt resolutions.
• Negotiate with non‑panel providers and liaise with insurers to secure preferred services.

Required profile

• Proven experience in health and benefits consulting or case management.
• Ability to lead day‑to‑day communication with clients on claims and care issues.
• Strong understanding of insurance processes, pre‑authorization, and claim documentation.
• Experience coordinating wellness programs and managing multi‑vendor events.
• Excellent stakeholder management skills across hospitals, insurers, and clients.

Required skills