Claims Assessor, Bupa Global
We are looking for a Claims Assessor who will be based in Cairo. This individual will be acting as the liaison between the patient and care personnel to ensure that all necessary care is provided promptly and effectively throughout the course of treatment.
Ensures the medical services with participating/ nonparticipating providers are given for the best prices that meet the reasonable and customary charges.
Authorization of Care managed pre-authorizations in terms of reviewing and investigating the following:
- The onset date of Symptoms.
- Antilog of the condition.
- Appropriate treatment is given.
- Correct treatment protocol is followed throughout the treatment course.
- Be the member’s assigned spoke to manage the case since the beginning, to show ultimate care and enhance service.
- Appropriateness of the length of stay through monitoring day to Day progression, and daily treatment plan.
- Review eligibility of the proposed treatment in comparison with member’s benefits, and Bupa’s policies and Rules.
- Ensures the most effective treatments are given for reasonable and customary prices.
- Negotiations with providers to obtain reasonable and customary charges and provide alternatives where same treatment level can be obtained for better prices.
- Ensures the best medical and health service is given to our members by daily monitoring of their treatments given, discharge arrangements, while monitoring the clinical eligibility of the length of stay, treatment protocol that all falls within the reasonable and customary charges.
- Ownership of the cases, by directly contacting members regarding their care pre-authorizations until case is fully recovered by making sure to put the customer at the heart of all our process.
The Ideal Candidate
- A minimum of 1-year experience in Customer service.
- Capable of delivering team’s KPI’s
- Fluent Arabic and English Language is a must.
- Awareness of the Local Culture in terms of different provider’s relations ethics, and Member’s trends.
- Ability to negotiate medical regimes, protocols, and costs
- Strong ability to detect frauds.
High Value Claims checks in terms of:
- Ensures SLA’s are met.
- Checking Reasonable and Customary prices for every item in the invoice.
- Ensuring best medical practice has been given to the member.
- Review clinical eligibility of the treatment performed.
- Price negotiations with non-participating providers.
- Further Claims Quality checks.
- Ensure invoices have been settled in full to providers, before paying to members.
- Reviewing Cost of the medical services done.
- Establishing action plans based on case facts, best practices, protocols, jurisdictional issues and available resources.
About the Company
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 can deliver outstanding results for the business.
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.