MST Team Lead (night shift)
The MST Team Lead (night shift) is responsible for the continuity of the service out of regular office hours, with the ability to offer standard services to all Bupa portfolio. Support MST members (Medical Advisors) handling complex cases and those that require additional actions to successfully coordinate the discharge plan. Ensures members have a smooth transition to the next level of care and guarantee all the parts involved work harmonically, with fluid communication and clear expectations.
- Measures team member’s performance against key performance indicators. Evaluates and performs performance feedback while taking appropriate actions necessary to maintain optimal performance including disciplinary actions as required. Conduct periodically employee performance evaluations according to business expectations.
- Implement and carries out the progressive disciplinary process when appropriate as per established guidelines and policies. Enforces all company and departmental policies
- Manage time and attendance for direct reports. Monitor and review reports extra hours worked if needed.
- Evaluate and supervise the management and final resolution of emergencies including coordination of medical evacuation.
- Ability to handle and explain the benefits for any Bupa product.
- Review and take final decision on Claims classified as PDOC (pending doctor review) within the turnaround time established.
- Responsible for complete detailed review of claims allocated under special benefits: Transplant, Maternity riders and Congenital.
- Provide outstanding customer service internally and externally to reinforce our brand in the market.
- Guarantee correct identification of Simple vs Complex cases to follow the Standard Operational Procedures established for Pre-authorization and Case Management.
- Complete the assignment of cases for the following day
- Identification and escalation of potentially fraudulent activity identified at any time of the evaluation process.
- May perform other functions as assigned by Regional Manager or Head of MST.
The Ideal Candidate
- Medical graduate with at least five (5) years of experience in the medical or insurance field and at least two (2) year practicing medicine is required.
- Minimum of 3 years’ experience in a customer service environment is required.
- Minimum 3 – 5 years of experience handling and resolving medical complex cases is required.
- Bilingual English / Spanish with the ability to write correspondence and verbally respond to inquiries and questions in both languages is required. Additional ability to communicate in other language is a plus.
- Knowledge of commonly-used insurance concepts, practices, and procedures is required
- Excellent communication skills
- Good analytical and problem-solving skills sufficient to identify issues and assess problems through resolution.
- Basic knowledge of MS Office suite including word., Outlook and Excel to create correspondence.
- Multi-cultural experience is preferred.
- Experience in a supervisory, management or leadership role within a team environment is preferred.