Medical Case Manager
il y a 7 jours
Foyer Global Health is the international health insurance brand of Foyer Group, Luxembourg's leading insurance company. We provide first-class health coverage to globally mobile individuals and are part of a growing, innovative environment with a strong international focus.
GoalWe are seeking an experienced Medical Case Manager to join our Partner and Medical Management team. This role involves assessing medical risks for underwriting and managing complex medical cases from insurance claims to ensure optimal outcomes for clients and the company.
As a key member of the medical team, you will contribute to cost-containment strategies and case management initiatives. The ideal candidate combines a strong medical background with analytical skills and expertise in medical underwriting and case management.
Responsibilities:Medical Underwriting
- Assess medical information and risks for new and existing applications.
- Apply risk mitigation measures (exclusions, loadings, denials) in line with guidelines and regulations.
- Maintain and update underwriting processes for individual and group business.
- Act as escalation point for complex cases and clearly explain decisions.
- Collaborate with stakeholders and support product development and internal training.
- Manage underwriting literature, tools, and reporting.
Medical Case Management
- Review medical necessity of treatments and ensure benefit alignment.
- Advise on cost reasonability and prevent fraud/overutilization.
- Manage high-cost cases, emergency assistance, and renewal reviews.
- Track savings, analyze data, and provide reports.
- Develop internal medical guidelines and deliver training to teams and partners.
- Medical Background: Preferably a qualified Medical Doctor or experienced Nurse with a health insurance background or a health care professional with 3-5 years of working experience.
- Medical Knowledge: Comprehensive understanding of medical terminology, healthcare regulations, and medical coding in an international setting.
- Certification: Preferred in Medical Underwriting and/or Case Management.
- Demonstrates the ability to make balanced, well-informed decisions by integrating clinical knowledge, internal guidelines, and regulatory requirements.
- Possesses strong analytical judgment to weigh multiple factors—such as medical evidence, cost implications, and ethical considerations—before arriving at a conclusion.
- Equally adept at substantiating and articulating decisions in a clear, rational, and transparent manner to diverse stakeholders, including internal teams, and external partners. This includes communicating underwriting rationale using evidence-based arguments that foster trust and understanding.
- Analytical Skills: Strong attention to detail and compliance.
- Communication: Excellent verbal and written skills in English; knowledge of German, French, and Spanish is an asset.
- MS Office and Data Analysis: Proficiency required.
- A multicultural, learning and innovative work environment,
- Flexible working hours,
- The benefits of a large group with the flexibility of an SME.
- The possibility of homeworking
- A company restaurant at preferential rates,
- A gym with a trainer,
- Hospitalization and group insurance
- Concierge service
Languages English Experience 3+ years
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