Assistant Case Manager
The Assistant Case Manager will report to the Case Manager with the primary goal of individual case management of medical cases as specified by the business to ensure balancing between high quality and cost-efficient health care is delivered to customers.
- To investigate, and response to enquiries for complex medical pre-authorization and high value claims from different internal and external shake holders including but not limited to members, providers, service providers and intermediarties in the appropriate method, in line with Bupa Gloabl policy and management style
- Ensure the correct interpretation of Bupa Global’s policies and rules, using the appropriate coding system to process the data and information accurately.
- Identify opportunities to reduce future claim expense for Bupa Global
- Proactively negotiate medical cost based on evidences to achieve either reducted cost to the buesiness
- Proactively identify fraud and/or abuse and reports to appropriate parties
- Assist Regional Case Manager to oversee member’s progress and monitor the discharge plan drafted.
- Assist Regional Case Manager to prepare documents and reports required for internal and external shake holders in the scope of case coordination activities and/ or data collections.
- Assist Regional Case Manager to input clinical information into computer database, under the supervision of regional case manager
- Assist Regional Case Manager with projects in ad-hoc basis
The Ideal Candidate
- Bachelor Degree or above in healthcare or communication related discipline
- RN experience with speciality (local or overseas) is preferred. OR
- At least 2 years of solid experience in utilisation review or case management in IPMI environment.
- Excellent knowledge of Microsoft Word and Microsoft Excel is a must.
- Good interpersonal skills and ability to work with a team is a must
- Excellent analytical and critical thinking skills
- Respects diversity and embraces cultural difference
- Highly customer focused and able to place customer’s health and benefit in the first priority.
- Understand the business commitment to meet deadline and turn-around time
- Proficient communication skills in English and Cantonese is essential and proficiency in Mandarin is preferred.