Claims Relationship Manager
The Claims Relationship Manager is responsible for liaising across departments, regarding all processes, communication and ensuring the operational part of the business is in compliance with the agreements. The position will also be accountable to manage the relationship with resources from the other areas of the organization within each initiative. The Claims Relationship Manager is required to have be an expert, and have full understanding of the Bupa Latin America suite of products and its operational administration and provide training as needed. The Manager assumes a proactive approach to delivering exceptional processes and standards that enable the delivery of excellent service and quality. Creates and develops a framework of how to anticipate and resolves issues. Identifies, communicates and resolves departmental and inter-departmental issues, concerns or complaints with a sense of urgency in order to ensure partner satisfaction.
The position is accountable directly or by direct supervision of:
- Liaison with both DR and Miami Claims Processing teams for all matters concerning the various claims areas. Also serves as a liaison for the Support Services team and other areas.
- Provides support, and training for associates, Managers, and others as needed.
- Documents processes and creates/updates manuals where appropriate including TPA guidelines.
- Monitors and evaluates trends, identifies potential areas that can cause errors in processing, procedures, and makes recommendations to Management for changes or adjustments.
- Creates documentation of trends and logs processes/potential issues to share with Management Team.
- Actively participates and serves as an SME in projects or initiatives that are implemented in the department.
- Interacts with Team managers to assure consistency across the different policies
- Performs other related tasks as assigned.
- Integrate and interact with other areas of the business to ensure appropriate design and delivery of the new initiatives
- Assist in decision making for important department implementations and procedures.
- Keep a knowledge base that can be used for the entire organization in future initiatives
- Work in teams with other departments, especially with IT department, to coordinate actions and deliveries.
- Serves as the contact person and subject matter expert for all questions regarding medical billing and coding within the organization.
- Perform risk management and incident management activities.
- Identify training needs and ensure its delivery.
The Ideal Candidate
- Bachelor’s degree required.
- Insurance or health care experience 2-3 years preferred.
- Certified in medical billing and coding
- Significant experience in Claims Processing and Quality Control practices
- Experience in managing Stakeholder and Senior Management expectations
- Excellent verbal and written skills in Spanish and English. Portuguese a plus.
- Must be available to travel up to 50%
- Solid background and knowledge of the Bupa Latin America portfolio and claims processes
- Very good verbal and written skills in the English and Spanish languages.
- Ability to work in a self-managed environment with little supervision and high expectations for timely system updates and partnership related data reporting.
- Communication skills: ability to resolve issues and communicate results. Ability to ensure appropriate flow of communication between teams involved in the agreed operational models.
About the Company
Bupa Global is an Equal Opportunity Employer
Bupa is an equal opportunity employer and in compliance with the law prohibits discrimination against applicants and employees based on the following characteristics: veteran status, uniformed service member status, sex, race, color, ancestry, national origin, religion, age, marital status, sexual orientation, pregnancy, childbirth and related conditions, familial status, citizenship, sickle cell trait, AIDS/HIV status (actual or perceived), genetic information, testing or characteristics or any other legally recognized status entitled to protection under federal, state, and local anti-discrimination laws. Bupa’s Equal Employment Opportunity Policy applies to all applicants and employees with respect to all terms and conditions of employment, including recruitment, hiring, training, compensation, transfer, layoff recall, benefits, promotion and separation.