The Case Manager will report to the Head of Health Risk Management BGAPAC with the primary goal of individual case management of medical cases as specified by the business to ensure quality care whilst balancing financial savings. This role ensures that all parties (broker, company, provider, service partner, colleagues) involved are kept up to date on the progress of authorisation.
• Investigate, and respond to enquiries for complex medical authorisations and high value claims from members, providers, group secretaries, service partners and intermediaries in the appropriate method, in line with Bupa Global policy and management style.
• Pro-actively contact members, providers, service partners and intermediaries via telephone, email, fax and letter to advise on decision of request and fully explain benefit entitlement to all parties.
• Ensure the correct interpretation of Bupa Global’s policy and rules, using the correct compatible combinations of codes for accurate processing of data, in accordance with our service standards and customer expectations
• Liaise with Global clinical staff to interpret condition and treatment to the rules and regulations of Bupa Global
• Liaise with all areas of the business to assist with resolving enquiries, such as underwriting and claims
• Provide advice to front line staff to support the process of pre-authorisation across the region
• Identify opportunities to reduce future claim expense for Bupa Global and to pro-actively provide relevant information to Risk management department
• Proactively negotiate medical costs and/or medical treatment to achieve either reduced cost to the business or most appropriate treatment for member.
• Develop and maintain an up to date and accurate knowledge of appropriate Bupa products, policies and initiatives in order to ensure that all queries are answered accurately.
• Support Bupa Global Greater China operation team on medical knowledge and advice
• Backup HK/China Case Manager for BGGC case management. Achieve departmental and individual KPIs
• Take responsibility for the logging of written queries and complaints on the customer database, ensuring it is up to date and as accurate as possible.
• To comply with and take into account any requirements from the local regulators and/or any applicable local regulatory requirements
• Support Pre-auth / medical review / provider enquiry in HK or China
The Ideal Candidate
• Experienced professional with knowledge of the HK/China Healthcare market;
• Knowledge and understanding of health insurance products and handling health insurance claims;
• Excellent experience in understanding medical issues and being able to read and understand complex medical journals and cases;
• Ability to be empathetic and view issues from the customer’s perspective whilst maintaining professional and friendly attitude;
• Ability to create and keep overview and solve complex issues;
• Keeping a pro-active mind-set;
• Significant knowledge and cultural understanding of the various regions and its market;
• An ability to speak fluent English and Mandarin and Cantonese (for HK) is needed;
• Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes;
• Ability to inspire and create enthusiasm, energy and cooperation in others to achieve work objectives;
• Demonstrated understanding of contact centre practices, dependencies and operations (desirable);
• Proficient in negotiation with healthcare providers (doctors, hospitals, etc) to manage claim costs, including challenging providers regarding care pathways and treatment plans, negotiating reasonable and customary rates, discounts etc.;
• Effective knowledge of Bupa products, systems, policy, internal structure and function. (desirable)
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 29M customers in 190 countries. With no shareholders, we invest our profits to provide more and better healthcare and fulfil our purpose. We employ almost 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.
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, to improve the health of the world. We are looking for individuals who are capable of delivering extraordinary business outcomes.
Bupa Global is the worldwide Bupa business. We provide products and services worldwide to people who want access to premium healthcare at home or as they study, live, travel or work abroad. Bupa Global provides international health insurance, travel insurance and medical assistance to individuals, small businesses and global corporate customers all around the world.
Bupa Global has over 1,500 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, Bupa Global Greater China, Bupa Global Latin America, Bupa Global North America and Bupa Global Rest of World.