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Underwriter & First Claim Assessor

Job Introduction

Role Purpose:

Make decisions on Underwriting using clinical and medical risk knowledge. Ensure that all applications for membership are underwritten in a consistent and accurate manner, resulting in maximum risk protection.

Act as an expert point of reference on all aspects of underwriting and business policy to provide clarity, consistency and guidance to all areas of the business.

Make decisions on potential non-disclosure cases using clinical and medical risk knowledge. 

Ensure that all decisions are made in a consistent and accurate manner, resulting in maximum risk protection.

Act as an expert point of reference on all aspects of non-disclosure to provide clarity, consistency and guidance to all areas of the business.

Role Responsibility

  • Understand and assess the medical risks associated with medical conditions and the range of potential treatments and their costs;
  • Ensure that all new applications for membership are underwritten in a consistent and timely manner so that they are processed within the agreed Service Level;
  • Consider the business implications and customer needs associated with the medical risk assessment as appropriate to protect the fund;
  • Act as an expert point of reference to other areas of the business and Bupa International in relation to underwriting and business policy;
  • Articulate to Business colleagues, intermediaries, customers and the medical profession BUPA’s requirements and processes for Underwriting. Including the history of it’s development and the ongoing review process in a clear, knowledgeable and customer friendly manner;
  • Keep up to date with any policy changes that have an effect on medical risk;
  • Carry out review projects for development of policy changes, medical advancements and underwriting developments. Carry out risk analysis. Communicate the outcome of the project in the most appropriate way. Compile and maintain a project file continually updating medical developments;
  • Work with the Head of Underwriting to identify changes to working practices and processes, and to implement and follow the changes as required;
  • To provide a high quality service to Bupa Global internal team in respect of technical aspects of Bupa International policies, products and underwriting queries relating to future applicants and existing members;
  • To resolve promptly and fairly to written queries from members and other parties in respect of underwriting decisions;
  • Deal with referrals from other areas of the business in respect of potential underwriting implications, or large cases and substandard risks and policy cases;
  • To monitor the quality of business from all sales channels, reporting to China Service Manager and Head of Underwriting, recommending action as appropriate;
  • To request further medical information, where necessary in order to process an application to join/upgrade. To follow up these requests to prevent a no sale wherever possible;
  • To maintain up to date knowledge of all Bupa Global products to ensure accurate assessment of risk and giving advice to third parties.
  • To provide input where required to literature and form design for new products or changes to existing products;
  • Carry out thorough and detailed investigation of cases referred into the team to determine whether the symptom or condition being claimed existed prior to the patient’s original date of joining Bupa Global, and was not disclosed at the point of application;
  • Use medical risk assessment techniques to assess the level of potential medical risk associated with the claim;
  • Pro-actively contact members, providers, service partners and intermediaries in the most appropriate way in order to gain enough information needed in order to make a decision, hospital or clinical visit as needed;
  • Be tenacious in approach, pursuing each case to the best of our ability ensuring that we explore every appropriate angle, and gain the widest and most comprehensive view of the case before making a decision;
  • Apply business rules and medical policy to make the most appropriate and accurate decisions for the business, the member and our members as a whole;
  • Ensure that all appropriate parties are kept up to date with the progress of the case until it has been resolved; this includes identifying the most appropriate form of communication and proactively contacting the member and provider;
  • Use all available resources to gain a complete picture of the case. This includes working with Clinical colleagues within Bupa International and in Bupa Group, and carrying out research using the internet in order to interpret the condition and the treatment and make the most appropriate decision;
  • Liaise with other areas of Bupa International to gain information required in order to make a decision. This includes claims, SIU, sales and customer service;
  • Identify those cases where reckless non-disclosure or fraud is apparent, and escalate cases to Head of Underwriting or SIU as appropriate. Provide the full and robust information required, including a recommendation, to enable the Head of Underwriter to make a decision whether to lapse the member for misrepresentation or reckless non-disclosure;
  • Articulate to business colleagues, intermediaries, customers and the medical profession Bupa International’s requirements for medical risk assessment;
  • Maintain up to date knowledge of Bupa Global products, policies and systems;
  • Ensure all cases are dealt with in a consistent and timely manner and in line with the agreed Service Level Agreement;
  • Act as an expert point of reference to other areas of Bupa International in relation to non-disclosure cases and policy;
  • Deliver the underwriting or first claim knowledge to relevant parties as required;
  • Participate BCB weekly performance call in regards to the workload and issues of underwriting and first claim;
  • Report underwriting and first claim workload to BCB operation manager on monthly basis;
  • To comply with and abide by the requirements of the Financial Services Authority (FSA) and Financial Ombudsman Service (FOS) at all times.

The Ideal Candidate

  • Experienced professional with knowledge of the global health insurance market, or relevant transferable skills and knowledge from other financial services industries such as Life Insurance, Retail, Commercial or Investment Banking and Wealth Management;
  • Significant knowledge and cultural understanding of the various regions and its market, and an ability to speak Mandarin and English;
  • A track record of achieving and exceeding targeted business results/KPIs;
  • Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes;
  • Strong stakeholder management experience, with the ability to build and strengthen relationships within the business at all levels;
  • Project management experience including demonstrating successful process improvement initiatives (desirable);
  • Ability to identify sources of data, analyse data and make rational decisions and recommendations. Construct a reasoned case, providing sound justifications;
  • Ability to work on own initiative with minimal guidance;
  • Sound medical knowledge, gained through internal training and experience and/or previous medical background;
  • Strong sense of customer focus, considering impact on customers and business and responding promptly and co-operatively to internal and external customers balancing decisions with the needs of the customer and of the business;
  • Diplomatic and self-confident, creating an environment of professionalism and trust;
  • An ability to speak fluent Mandarin and English is needed.

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 globally. With no shareholders, we invest our profits to provide more and better healthcare and fulfil our purpose. We employ 86,000 people, principally in the UK, Australia, Spain, Poland, New Zealand and Chile, as well as Saudi Arabia, Hong Kong, India, and the USA.

We have grown significantly, particularly through 2013 to 2015, when we accelerated execution of our 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's Strategic Framework

Our strategy has three pillars: Customers, People, Performance. It puts our customers front and centre in the context of today’s digital age. As a service organisation, everything we do for our customers relies on our people and partners, so being a place where people love to work is critical to our success. This, combined with disciplined risk and capital management, is how we will deliver strong and sustainable performance.  We are looking for individuals who share in our values and this strategy, and are capable of delivering outstanding results for the business.

Bupa Global

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 Africa, India & Middle East; Bupa Global Greater China; Bupa Global Latin America; Bupa Global North America and Bupa Global Europe.

Bupa

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