The health insurance consultant is the guarantor of access to rights and payment of benefits for each insured. Its action allows policyholders to seek treatment regardless of their situation. Responsible for the quality of the files, he ensures the conformity and the accuracy of the information before proceeding to the allocation of specific rights, to a payment, to a refund, or to the payment of an indemnity by referring the regulations and procedures in force.
As such, he also works directly with policyholders to inform them about their rights and guide them in the event of questions.
In practice, the advisory manager analyzes and manages the insured’s file. He collects the necessary information, uses the supporting documents, enters the information into the information system and checks its consistency. It also calculates the amount of benefits due in order to allow payment.
It ensures the quality of the service by making the data more reliable, detecting and analyzing anomalies and by exploiting rejections and reports.
He can also intervene directly with the insured, mainly by email or by post. He informs them of their rights and obligations, supports them in the management of their file, directs them if necessary to the competent interlocutor and offers them an adapted service offer.
SKILLS AND QUALITIES
- Analysis and adaptation skills
- Analytical mind
- Sense of customer relationship
TRAINING (DIPLOMA AND TRAINING (S) OFFERED INTERNALLY)
The position of Health Insurance Advisory Manager is accessible from Bac to Bac + 2 level in the field of administrative management
Specific training aimed at certification is offered in particular to understand the tools and regulations used by health insurance.