Job Description
Job title: Healthcare Plan Case Manager
Location: Tewkesbury(Hybrid)
Salary: £26,500 to £27,500 per annum
Status: Permanent
Working Hours: Mon - Friday. Office hours are 8am to 6pm. Working on a 3 weekly Rota (8am to 4,30pm (Early) , 9.30am to 6pm (Late) and Flexi week)
HCML is the UK’s leading provider of rehabilitation, case management, occupational health, and workplace wellbeing services. We’re proud to be recognised as a 2025 UK’s Best Workplace for Wellbeing, reflecting our commitment to supporting the growth, development, and wellbeing of our people.
We are seeking a Healthcare Plan Case Manager to join our Healthcare Plan team and play a vital role in delivering a seamless and customer focused experience. You’ll support individuals through their healthcare journey, providing expert guidance, managing cases with care and precision, and ensuring outcomes align with clinical best practice and plan rules. Working in a collaborative, fast-paced environment, you’ll combine empathy with analytical thinking to make a real difference to people’s health and wellbeing while maintaining high standards of quality, compliance, and service excellence.
Purpose of Role:
To provide an effortless journey for all members making claims via their company Healthcare Plan while always adhering to the respective Rules and Benefits.
The Healthcare Plan Case Manager will act as a trusted point of contact, balancing empathy with expertise to support members in understanding their condition, navigating available healthcare options, and actively engaging in their recovery. This includes applying plan-specific Rules and Benefits, managing costs responsibly, and ensuring all decisions are fair, transparent, and compliant with regulatory and clinical standards.
Key Responsibilities:
Establish the current reason for ill health/injury and identify any underlying cause or contributory risk factors.
Be instrumental in the multidisciplinary assessment process by ensuring sufficient information is gained to assess personal and occupational risk factors.
Effectively communicate to the member the multifactorial issues associated with the current episode of ill health/injury and how they can personally address the risk factors within their control.
Follow managed care pathways, NICE and evidence-based guidelines.
Where appropriate, review both private and NHS options when making onward referrals for consultations, investigations and treatment.
Demonstrate a clear understanding of the Rules & Benefits for each individual plan and keep up to date with any changes/amendments made to these policies.
Source appropriate treatment providers whilst always adhering to guidelines outlined in the Rules & Benefits.
Always manage claims within the restraints of the Rules & Benefits.
Ensure any escalations are managed using the appropriate processes and guidelines.
Ensure that all information is accurately recorded in CRM.
Meet all legal compliance requirements and healthcare quality assurance standards.
Demonstrate a professional and respectful approach during all interactions, whether internal or external.
Ensure that costs are managed so they are fair and appropriate and no greater than regional averages.
Work seamlessly with the onsite Functional Health Team to both take referrals and provide tasks for them, adding a three-dimensional approach to the case and specifically reviewing objective measurements where appropriate.
Maintain knowledge on all aspects of integrated health risk management.
Take responsibility for recognising any training needs and discuss them with your Line Manager.
Take accountability for any errors, including DPA breaches, via prompt reporting to your Line Manager or other Senior Manager.
Demonstrate teamwork ethos.
Demonstrate entrepreneurial flair and best-in-class innovation.
Undertake any other task as may reasonably be required by the company.
Develop and sustain relationships with both internal and external customers, remembering you are the face and voice of healthcare rm.
The above to be measured via various metrics including audit of calls, reports, system entries, evidence of CPD and Performance Reviews.
Person Specification:
Experience
Essential
Good IT knowledge
Experience of managing workload to meet customer deadlines and service standards
Experience of working with little supervision while recognising when to seek support
Experience of maintaining productive working relationships
Desirable
Claims management experience
Skills & Knowledge
Essential
Ability to use Microsoft Office (Word, Teams, Excel, Outlook, PowerPoint)
Confident telephone skills, including effective listening and empathy (inbound and outbound)
Analytical and problem-solving skills
Ability to adopt an investigatory approach and remove obstacles
Ability to understand the impact of ill health on work and individuals
Planning and organisational skills to meet objectives
Desirable
Knowledge of Clinical and non-clinical care pathways
Knowledge of GDPR, Data Protection Act (DPA) and ICO guidelines
Knowledge of Occupational health and relevant legal principles
Knowledge of Workplace ill health/injury management practices
Ability in conducting telephone assessments using motivational interviewing or similar techniques
Knowledge of organisational performance and procedural standards
Attributes
Empathy and strong interpersonal skills
Self-motivated with the ability to work independently
Proactive and investigative mindset
Attention to detail
Resilient and able to manage competing priorities
Professional and customer-focused approach
Qualifications and Training
Essential
English and Maths GCSE Grade C (or equivalent) or above
Desirable
Degree-level education or equivalent professional certification
Company Benefits:
Medicash Health Cash Plan: Which includes ability to claim back dental, optical, and chiropody costs. Plus, add your dependent children for free! + 24/7 Digital Health: Round-the-clock access to a virtual GP helpline and an Employee Assistance Programme (EAP) + Mental Health Support: Up to 8 fully funded face-to-face counselling or CBT sessions
Pension Scheme & Pension Salary Sacrifice
Peace of Mind: Rest easy knowing your loved ones are protected with a Death in Service benefit equal to 4x your base salary
Payroll Giving: Support the causes you love directly from your gross pay
Annual Leave: 25 days + BH, plus Birthday Leave to celebrate your special day
Flexibility: Option to buy or sell up to 3 days of holiday each year
Giving Back: Up to 2 fully paid Volunteering/Community days per year
Family First: Enhanced, generous Maternity and Paternity policies, alongside comprehensive Company Sick Pay
Professional Development: We fund professional subscriptions and registrations post-probation, alongside internal promotion and secondment opportunities
Rewarding Excellence: Annual pay reviews and regular staff awards to celebrate your hard work plus a regular events and activities throughout the year
Equal Opportunities Statement:
HCML is committed to equality of opportunity for all staff and applications from individuals are encouraged regardless of age, disability, sex, gender reassignment, sexual orientation, pregnancy and maternity, race, religion or belief and marriage and civil partnerships.