Relationship and Implementation Manager
Responsible for liaising across departments, regarding all processes, communication and ensuring the operational part of the business is in compliance with the agreements. The position will also be accountable to manage the relationship with resources from the other areas of the organization within each initiative. The Relationship and Implementation Manager is required to have be an expert, and have full understanding of the Bupa Latin America suite of products and its operational administration and provide training as needed. The Manager assumes a proactive approach to delivering exceptional processes and standards that enable the delivery of excellent service and quality. Creates and develops a framework of how to anticipate and resolves issues. Identifies, communicates and resolves departmental and inter-departmental issues, concerns or complaints with a sense of urgency in order to ensure partner satisfaction. Represents the Transformation and USSC Team in the relationship with third parties or within departments, and reviews that established guidelines are followed.
The position is accountable directly or by direct supervision of:
- Manages escalations: Coordinates with all areas of the business to identify, communicate and resolve issues related to USSC services and preauthorization process.
- Ensures that all department guidelines, KPIs and TAT objectives are met, including individual staff members, schedules and process adhereance, as required by the business.
- Represent the USSC and also Bupa operational processes and interests during Projects, Products Implementation, New regulation, or product role outs, etc.
- Attends escalated issues and resolves complex problems directly with the internal areas and partners (networks).
- The liaison for Automation projects, Integrated Networs and the USSC clinical support functions.
- Oversee the local team members responsible for the USSC general servicing and preauthorization of treatment for Bupa members. Coordinates and conducts daily to weekly meetings with USSC members and MST, Claims, Regional management, Change or IT as required.
- Liaison with all markets serviced by the USSC, as well as liaison between US Claims and related MST teams for all matters concerning the various preauthorizations and medical services areas.
- Monitors and evaluates trends, identifies potential areas that can cause errors during case’s evaluations/preauthorization, and makes recommendations to Management for changes or adjustments.
- Actively participates and serves as an SME in projects or initiatives that are implemented in the department. Also serves as a liaison for the IT, Support Services team and other areas, with special focus on insurance process automation.
- Provides support, and training for associates, Managers, and others as needed. Documents processes and creates/updates manuals where appropriate including TPA guidelines.
- Creates documentation of trends and logs processes/potential issues to share with Management Team.
- Interacts with Team managers to assure consistency across the different processes and policies
- Performs other related tasks as assigned.
- Integrate and interact with other areas of the business to ensure appropriate design and delivery of the new initiatives.
- Assist in decision making for important department implementations and procedures.
- Perform risk management and incident management activities.
- Defines and documents the framework for managing a relationship within the US Services Team and other departments such as: Claims, Finance, Quality Control, Customer Service, Support Services, MST and Provider Services.
- Identifies training needs and/or process improvement opportunities.
- Acts as the change management lead for departmental changes and implementations.
- Delivers a structured and recurrent communication to the USSC, MST, and Claims Department to ensure alignment within the department and other internal areas, in regards to the nature of key updates and issues.
- Works closely with USSC Service Team Managers and Head of Change & USSC, to provide ongoing feedback.
- Provides assistance and support on issues/tasks as assigned
The Ideal Candidate
- Medical graduate with at least five (5) years of experience in the medical or insurance field and at least two (2) year practicing medicine is required.
- Insurance or health care experience 2-3 years preferred.
- Minimum of 2-3 years’ experience in a customer service environment is required.
- Minimum 3 – 5 years of experience handling and resolving medical complex cases is required.
- Bilingual with Professional level English / Spanish with the ability to write correspondence and verbally respond to inquiries and questions in both languages is required. Additional ability to communicate in other language is a plus.
- Must be available to travel
- Knowledge of commonly-used insurance concepts, practices, and procedures is required
- Excellent communication skills
- Good analytical and problem-solving skills sufficient to identify issues and assess problems through resolution.
- Basic knowledge of MS Office suite including word., Outlook and Excel to create correspondence.
- Multi-cultural experience is preferred.
- Experience in a supervisory, management or leadership role within a team environment is preferred.
- Excellent customer service and sound interpersonal skills to appropriately handle escalated issues.
- Excellent organizational, time management, prioritizing and multitasking skills in order to mange team’s workload.
- Demonstrated initiative, flexibility and ability to embrace and drive change.
- Ability to work in a multi-ethnic and multi-cultural environment.
- Excellent interpersonal skills characterized by effective interactions with a diverse range of internal and external stakeholders and audiences.
** Please assure to include and upload an updated copy of your Resume to your application/profile **
** Porfavor, Asegúrese de incluir y cargar una copia actualizada de su currículum en su solicitud/perfil. **