Quality Control Specialist
Performs Quality Control of the Underwriting and Claims procedures currently established, ensures that a high level of accuracy is consistently achieved while minimizing potential losses to the business. QC Specialist ensures that high performance is delivered, within the area of responsibility, for operational effectiveness and customer retention. The QC evaluation reinforces operational standards and improves processes to consistently deliver the highest level of accuracy ensuring that responsibilities are performed in accordance with documented processes. Tracks reviews via company provided software application.
- Reviews quality control reports daily. Monitors volume of pending reviews to ensure the operational guidelines and expected level of service and accuracy are met.
- Performs a detailed assessment of the executives performance, including but not reduced to the execution of a medical evaluation, policy approval, changes of plan; dependents release; removal of endorsements; application of payments such as premiums and/or cancelation and reimbursements of non-used premium; etc
- Performs a detailed assessment of the executives performance, including but not reduced to the execution of medical compensability of claims being reviewed; application of usual, costmary and reasonable charges; properly assess the application towards policy benefits while applying policy guidelines.
- Ensure that productivity and quality service level established by the company are met and escalates findings to management for review and loss prevention.
- Perform other related tasks as assigned
The Ideal Candidate
- High School Diploma required. Associates Degree preferred. 4 to 6 years of experience in the operational sector of the health insurance field, preferably in the quality control; and or claims processing department.
- Knowledge of commonly used concepts, practices and procedures within the insurance field
- Sound knowledge of Microsoft office software
- Bilingual English/Spanish. Portuguese is a plus. Writes reads and composes correspondence in both languages.
About the Company
Bupa’s purpose is longer, healthier, happier lives.
As a leading global health and care company, we offer 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. We have 32M customers in 190 countries. With no shareholders, we invest our profits to provide more and better healthcare and fulfil our purpose. We employ 84,000 people, principally in the UK, Australia, Spain, Poland, New Zealand and Chile, as well as Saudi Arabia, Hong Kong, India, Thailand, and the USA.
We have grown significantly, particularly through 2013 to 2015, when we accelerated execution of our Bupa 2020 strategic vision. We are similar in revenue and profit to Marks & Spencer, and larger than Heinz in revenue. 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.
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, and fulfil our purpose: longer, healthier, happier, lives. We are looking for individuals who are capable of delivering extraordinary business outcomes.
Bupa’s International Markets (IM) unit has 16 million customers in 190 countries across all continents around the world. It manages a portfolio of businesses, including a large international health insurance, travel insurance and medical assistance business called Bupa Global, as well as established domestic health insurance businesses in Hong Kong and Thailand, two associate health insurance companies in Saudi Arabia (26.25% Bupa ownership) and India (49% Bupa ownership), and Hong Kong’s largest private clinic network.
Bupa Global provides products and services worldwide to people who want access to premium health and care at home or as they study, live, travel or work abroad. We provide international health insurance, travel insurance and medical assistance to individuals, small businesses and global corporate customers all around the world.
Bupa Global has over 1,800 employees and has offices in London and Brighton (UK), Miami (USA), Copenhagen (Denmark), Hong Kong (Greater China), and Dubai (UAE), as well as in Egypt, Mexico, the Dominican Republic, Bolivia, Panama, Guatemala and Ecuador. Bupa Global is currently organised around five regional hubs: Bupa Global Middle East, Africa and India; Bupa Global Greater China; Bupa Global Latin America; Bupa Global North America and Bupa Global Europe.
Timescales for reviewing applications will differ between regions, but you will always receive a response to your application. The recruitment process itself will vary per role and region, but you will be updated along the way via phone and email (so please look out for these!). To view what stage of the process your application is currently at, you can also log in and view your dashboard.
If you are invited to an interview, a member of the resourcing team will be able to advise you on what to expect. This will vary in region, but will likely include an initial phone or digital interview, followed by one or more of the following depending on the role: Core capability interview; Technical/function specific interview; Online profiling assessment; Presentation, written task, role play; Assessment centre.
If your application is successful and you’re invited to join the team, the resourcing team will guide you through your on boarding journey.
Should you require any reasonable adjustments to be made or facilities provided to enable you to attend an interview, please do not hesitate to contact us prior to the interview at firstname.lastname@example.org, so we can make adjustments accordingly.