Sr. Medical Advisor (night shift)
The Sr. Medical Advisor (night shift) is responsible for the continuity of the services out of regular office hours, with the ability to offer standard services to all Bupa portfolio. To be able to handle and resolve emergencies along with the authorization of simple cases and prepare work assignments for the following day.
- To offer full MST services beyond regular office hours.
- 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.
- Review and take final decision on Claims classified as P25 (Claims over 25K) 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 be in compliance with 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.
- Knowledge of commonly-used insurance concepts, practices, and procedures is required.
- Ability to communicate in English and Spanish. Additional ability to communicate in other language is a plus.
- Multi cultural experience is preferred.
- Experience in a supervisory, management or leadership role within a team environment is preferred.