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Provider Partnership Advisor / Assistant Contracting Manager

Job Introduction

  • To provide efficient and effective support for participating providers in Singapore and SEA.
  • To manage the relationships between Bupa Global and participating providers in SEA on a day to day basis.
  • To enhance the provider’s experience of Bupa Global, through educational and informative, proactive and timely service.
  • To be a business champion to ProviderWorld, leading providers through the registration process, ensuring they have an understanding of the functionality and are able to self serve.
  • To support the positioning of Bupa Global as the expert in the international healthcare arena.
  • To support provider expansion in SEA.

Role Responsibility

Claims

  • Receive claims from providers and split any consolidated bills for each member
  • Adjudicate claims for:

o Eligibility of treatment in accordance with member’s plan rules and benefits

o Deductibles, co-payments etc

o Check against any pre-authorization decision if appropriate

o Compliance with provider contracts including rates charged and discounts

o Reasonable and customary treatment costs

o Appropriateness of treatment and medical utilisation

o Length of stay

  • Discuss queries or negotiate with providers as appropriate

 

 Case Management

  • Discuss / negotiate costs with in-network provider if necessary.
  • Support Case manager for intensive care, long-stay, high value and ongoing / recurring in-patient admissions.
  • Liaise with internal Case Management and Medical teams in BTN, CPH and Bupa Asia as appropriate

 

Claims and Payment Queries

  • To investigate statements of out-standing accounts from participating providers
  • Investigate aged –debt queries
  • Resolve claims / payment queries with contracted providers providing payment explanations
  • Resolve payment problems with contracted providers.
  • Provide clear explanations of Bupa Global decisions, referring to published policy where possible.
  • To make sound business decisions regarding ex-gratia payments.

 

Provider Contracting Enrolment and Maintenance

  • Provider Contracting and DB network establishment in Singapore and SEA
  • Communicating enrolment details to users.
  • Linking duplicate providers in SWAN and maintaining department central provider record sheet.
  • Update information and maintain records in SWAN systems regarding contracted providers.
  • Support the purchasing team in the operational implementation of new contracts and TPA’s in Bupa Brighton (BTN) and ihi Bupa Copenhagen (CPH).

 

Provider World (on-line portal for providers and TPAs)

  • Ensuring valid email addresses stored for each ProviderWorld user.
  • Unlock ProviderWorld accounts and reset account information; delete users from PW where appropriate.
  • Collate feedback from providers in relation to PW and services provided.
  • Monitor site usage and traction volumes through regular report analysis.
  • Provide usage feedback/escalate issues to Relationship Owners.
  • Report average time taken to resolve queries relating to PW.
  • Engage providers and promote the ProviderWorld site.
  • To actively seek feedback from providers in order to make improvements to the service offered.
  • Schedule and facilitate initial and refresher ProviderWorld training.
  • Ensure all ProviderWorld training material is maintained.
  • Communicate well in advance with all Service Partners and Providers of all site changes or enhancements.
  • Drive high level of provider satisfaction by handling providers’ PW requirements proactively

 

Reporting

  • Produce regular activity and savings reports in agreed formats

 

Query Handling

  • Conduct and handle Inbound & Outbound calls relating to general provider queries and those related to ProviderWorld.
  • Support claims and service departments in BTN and CPH in connection with questions around local pricing and billing practises for specific cases.

 

General

  • Build strong relationships with providers. Maintain regular communication on a proactive basis.
  • Work positively in association with colleagues especially in Healthcare Services, Claims and Bupa Asia
  • Set expectations with providers on incoming queries turnaround times.
  • Support claims, service and other teams in BTN & CPH on questions around local providers.
  • Support new product development, in particular for new processes regarding pre-authorisation and provider networks

 

The Ideal Candidate

  • Degree holder
  • Background in the global health insurance market, or relevant transferable skills and knowledge from other financial services industries such as Life Insurance, Retail, hospital or clinic, Commercial or Investment Banking and Wealth Management.
  • Previous experience of a complex and multi skilled customer facing roles within a contact centre setting
  • A track record of achieving and exceeding productivity and quality targets
  • Highly customer focused
  • Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes.
  • An ability to speak a second language would be an advantage

About the Company

Bupa is a leading global health and care company, offering health insurance, medical subscription and other health and care funding products; we run care homes, retirement and care villages, primary care, diagnostic and wellness centres, hospitals and dental clinics. We also provide workplace health services, home healthcare, health assessments and long-term condition management services. Bupa has over 30M customers in 190 countries and employs close to 80,000 people, principally in the UK, Australia, Spain, Poland, New Zealand and Chile, as well as Saudi Arabia, Hong Kong, India, Thailand, and the USA

Bupa is a purposeful, commercial organisation. Bupa's purpose is: longer, healthier, happier lives. It defines everything we do and is the reason we exist. With no shareholders our profits are reinvested to provide more and better healthcare fulfilling our purpose.

 

We have grown significantly, particularly over the past three years (2013, 2014 and 2015), when we accelerated execution of our Bupa 2020 strategic vision. We are targeting revenues in excess of £12Bn in 2015. Because Bupa does not have shareholders it does not have a listing, but if it did it would be in the FTSE 100. Bupa is not a mutual or a charity but a company limited by guarantee that seeks to maximise its profits in order to fulfil its purpose. With customers in virtually every country in the world and 70% of its revenues now generated outside the UK, Bupa is a truly international organisation.

Our people

Bupa believes that the growth and performance of our leaders and our people is the single biggest pathway to fulfilling our purpose (longer, healthier, happier lives) and delivering Bupa’s 2020 goals. We have a leadership framework called “Bupa Leaders Are” which sets out what great leadership looks like at Bupa. Leaders are called upon to grow themselves, to grow others, to grow the business, to improve the health of the world. We are looking for individuals who are capable of delivering extraordinary business outcomes.  

Bupa Global

Bupa Global is the worldwide Bupa business. We provide international private medical insurance products and services for globally minded and mobile people who want the most premium coverage and access to the best healthcare anytime, anywhere in the world, whether at home or when studying, living, travelling or working abroad. We have over 1,700 employees working for our circa 2million customers around the world. We have a medical advice line staffed by a team of experienced, multi-lingual advisers to offer our customers support 24 hours a day, every day. We also have an emergency medical team of doctors on hand as an optional benefit to organise emergency assistance and evacuations.

Bupa Global has key regional offices in London, Brighton, Miami, Philadelphia, Copenhagen and Hong Kong as well as commercial operations in Egypt, Mexico, the Dominican Republic, Bolivia, Panama, Guatemala and Ecuador. Bupa Global is currently organised around five regional hubs: Bupa Global Middle East, Bupa Global Greater China, Bupa Global Latin America, Bupa Global North America and Bupa Global Rest of World.

Bupa

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