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Provider Partnership Service Advisor

Job Introduction

  • To provide efficient and effective support for participating providers in Hong Kong.
  • To manage the relationships between Bupa Global and participating providers in Hong Kong on a day to day basis.
  • To enhance the provider’s experience of Bupa Global, through educational and informative, proactive and timely service.
  • To be a business champion to ProviderWorld, leading providers through the registration process, ensuring they have an understanding of the functionality and are able to self serve.
  • To support the positioning of Bupa Global as the expert in the international healthcare arena.
  • To support provider expansion in HK, Macau and Taiwan.

Role Responsibility

Pre –authorisation and eligibility checking

  • Respond to requests for pre-authorization of treatment from providers by telephone, fax and email in line with Bupa Global policy and management style.
  • Liaise with internal colleagues including Care Management, Healthcare Services, Claims department, ihi Bupa and Bupa Asia where appropriate.
  • To provide feedback and recommendations for business improvements on pre-authorisation processes and procedures. To monitor the effect of any recommendations.
  • Respond to provider queries about eligibility for out-patient treatment, and informing providers about coverage by BG and any member responsibility amounts.

Claims

  • Receive claims from providers and split any consolidated bills for each member
  • Adjudicate claims for:

o Eligibility of treatment in accordance with member’s plan rules and benefits

o Deductibles, co-payments etc

o Check against any pre-authorization decision if appropriate

o Compliance with provider contracts including rates charged and discounts

o Reasonable and customary treatment costs

o Appropriateness of treatment and medical utilisation

o Length of stay

  • Discuss queries or negotiate with providers as appropriate
  • Complete claims audit sheet for submission with claim including deductions and any savings made
  • Submit claims regularly to Claims departments ensuring prompt assessment and payment in line with provider contract terms

 Case Management

  • Discuss / negotiate costs with provider if necessary.
  • Support Case manager for intensive care, long-stay, high value and ongoing / recurring in-patient admissions.
  • Liaise with internal Case Management and Medical teams in BTN, CPH and Bupa Asia as appropriate

Claims and Payment Queries

  • To investigate statements of out-standing accounts from participating providers
  • Investigate aged –debt queries
  • Resolve claims / payment queries with contracted providers providing payment explanations
  • Resolve payment problems with contracted providers.
  • Provide clear explanations of Bupa Global decisions, referring to published policy where possible.
  • To make sound business decisions regarding ex-gratia payments.

Provider Contracting Enrolment and Maintenance

  • Provider Contracting and DB network establishment in HK, Macau and Taiwan
  • Communicating enrolment details to users.
  • Linking duplicate providers in SWAN and maintaining department central provider record sheet.
  • Update information and maintain records in SWAN and PSI systems regarding contracted providers.
  • Support the purchasing team in the operational implementation of new contracts and TPA’s in Bupa Brighton (BTN) and ihi Bupa Copenhagen (CPH).

Provider World (on-line portal for providers and TPAs)

  • Ensuring valid email addresses stored for each ProviderWorld user.
  • Collate feedback from providers in relation to PW and services provided.
  • Monitor site usage and traction volumes through regular report analysis.
  • Provide usage feedback/escalate issues to Relationship Owners.
  • Engage providers and promote the ProviderWorld site.
  • To actively seek feedback from providers in order to make improvements to the service offered.
  • Schedule and facilitate initial and refresher ProviderWorld training.
  • Ensure all ProviderWorld training material is maintained.
  • Communicate well in advance with all Service Partners and Providers of all site changes or enhancements.
  • Drive high level of provider satisfaction by handling providers’ PW requirements proactively

Reporting

  • Produce regular activity and savings reports in agreed formats

Query Handling

  • Conduct and handle Inbound & Outbound calls relating to general provider queries and those related to ProviderWorld.
  • Support claims and service departments in BTN and CPH in connection with questions around local pricing and billing practises for specific cases.

General

  • Build strong relationships with providers. Maintain regular communication on a proactive basis.
  • Work positively in association with colleagues especially in Healthcare Services, Claims and Bupa Asia
  • Set expectations with providers on incoming queries turnaround times.
  • Support claims, service and other teams in BTN & CPH on questions around local providers.
  • Support new product development, in particular for new processes regarding pre-authorisation and provider networks

The Ideal Candidate

  • Background in the global health insurance market, or relevant transferable skills and knowledge from other financial services industries such as Life Insurance, Retail, hospital or clinic, Commercial or Investment Banking and Wealth Management.
  • Previous experience of a complex and multi skilled customer facing roles within a contact centre setting
  • A track record of achieving and exceeding productivity and quality targets
  • Highly customer focussed
  • Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes.
  • An ability to speak a second language 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 and making a better world.

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 and making a better world.

Bupa Global

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.

Application process:

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 bupaglobalcareers@bupa.com, so we can make adjustments accordingly.

Bupa

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