Clinical Service Manager
Ensure that agreed operational services and case management is delivered at all times within the Customer Service Department through the effective leadership of our Case Managers and Medical Policy consultants across our region.
The focus of this role is to ensure that we are empowering, coaching, managing performance, delivering on SLAs and growing our people to deliver outstanding case management and cost containment against our agreed targets.
The Clinical Service Managers are responsible for the day to day delivery of value-based healthcare using case management, claims adjudication techniques and medical policy services 24/7/365 across the globe embracing a culture of continuous improvement with the team. We will ensure delivery of quadruple aims in funded healthcare, that is strong customer experience, excellent clinical outcomes, provider engagement and cost containment = better value healthcare.
Deliver global clinical case management and pre-authorisation services through:
- Operationalise case management and disease management programs for Bupa Global customers.
- Deliver high cost / complex case management and cost avoidance strategies in line with department targets.
- Coaching, developing and leading a highly skilled team of health professionals
- Maintaining and developing team and individual scope of practice, medical education and CPD requirements.
- Managing absences to the agreed standard
- Dealing with any performance issues
- Complete regular 121s with all team members
- Managing team performance and ensuring the agreed service outputs and customer experience
- Focus on delivering key targets on first touch / call resolution, Net Promoter scores, Customer Interaction Survey scores, quality assessments and savings targets.
- Ensure that team and partner resources are managed in line with the workforce plan
- Work closely with the Continuous Improvement partners, Medical Policy and internal Clinical Governance partners to ensure ongoing improvement and alignment of Healthcare Management (HCM) strategic objectives.
- Hold regular team meetings to ensure strong and engaging 360-degree communication and participate in wider HCM meetings and project work.
- Support and / or lead recruitment and succession planning function
- Drive the communication process within the department, including responsibility for all messages that are conveyed (with an emphasis on digital content and an engaging style)
- Accountable for the resolution of customer clinical case management and emergency assistance related issues that are identified by your team.
- Support development of and operational roll-out of reasonable and customary rates, clinical audit and medical underwriting initiatives across HCM and Bupa Global.
- Responsible for identifying/removing any barriers that impacts the delivery of outstanding customer satisfaction
- Ensures high levels of employee engagement, measured through eNPS (pulse surveys). Understands, acts and shares eNPS results with the team, building relevant actions plans for improvement.
- Ensure there are high levels of team working and that the team is aligned and engaged with Bupa’s purpose and goals
- Being a role model for the team demonstrating outstanding personal behaviours and performance. Being an ambassador for the function
- Responsible for discovering and implementing potential opportunities for improving the customer experience.
- Adherence to required regulatory guidelines and specifically financial conduct authorities’ regulations
Department specific accountabilities for this role:
- Works closely with the Healthcare Management and Clinical Governance team to ensure that processes across Clinical Operations are effective and support the best clinical and customer experience
- Point of escalation for customer issues that need to be referred by the Case Managers / Partners / Customer Service Consultants
The Ideal Candidate
- The candidate must be a qualified and registered clinician (nurse / doctor or allied health professional). Relevant secondary qualification in management / healthcare administration / customer service or related studies are highly desirable.
- Background in the medical health insurance or emergency assistance industries, or relevant transferable skills and knowledge from other financial services industries such as within Contact Centres, Life Insurance, Retail, Commercial or Investment Banking and Wealth Management.
- Substantial experience of leading a team in the delivery of hospital or community or digital health & wellbeing services.
- A track record of achieving and exceeding targeted business results/KPIs with remote multicultural teams.
- Able to establish a performance management culture. Evidence of building talented high performing clinical teams and getting the best out of highly talented health professionals working remotely whilst quickly and effectively managing performance issues
- Experience of managing employees who are leaders (for example a team coach or senior clinician) is advantageous.
- Strong ability to carry out effective coaching and development
- Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes across a remote team.
- Exposure to project work including demonstrating successful quality and process improvement initiatives.
- An ability to speak a second language and international working experience would be an advantage
About the Company
We are a health insurer and provider. With no shareholders, our customers are our focus. We reinvest profits into providing more and better healthcare for the benefit of current and future customers.
Bupa’s purpose is longer, healthier, happier lives.
Here you’ll be welcomed. We champion diversity and we understand the importance of our people representing the communities and customers we serve. You’ll find an inclusive environment where you can be yourself and where everyone is driven by the same purpose – helping people live longer, healthier, happier lives.
Bupa Global is the international health insurance division of Bupa. We provide customers who want premium international coverage with products and services to access the healthcare they need anytime, anywhere in the world, whether at home or when studying, living, travelling or working abroad.
Bupa Global has offices around the world including London and Brighton (UK), Miami (USA), Copenhagen (Denmark), Dubai (UAE, in partnership with OIC), and Hong Kong (China) as well as regional offices in mainland China, Singapore, Egypt, Mexico, the Dominican Republic, Bolivia, Brazil, Panama, Guatemala and Ecuador.
Timescales for reviewing applications will differ between regions, but you will always receive a response to your application. The recruitment process itself will vary per role and region, but you will be updated along the way via phone and email (so please look out for these!). To view what stage of the process your application is currently at, you can also log in and view your dashboard.
If you are invited to an interview, a member of the resourcing team will be able to advise you on what to expect. This will vary in region, but will likely include an initial phone or digital interview, followed by one or more of the following depending on the role: Core capability interview; Technical/function specific interview; Online profiling assessment; Presentation, written task, role play; Assessment centre.
If your application is successful and you’re invited to join the team, the resourcing team will guide you through your on boarding journey.
Should you require any reasonable adjustments to be made or facilities provided to enable you to attend an interview, please do not hesitate to contact us prior to the interview at email@example.com, so we can make adjustments accordingly.