Care-coordinator - BEI

Job Description:
Care Co-Ordinator - BEI
Bupa Egypt Insurance SAE - District 5 Campus, Building B07, Ain Sokhna Road, New Cairo 11361, Cairo
Full Time - Fixed Term (Rolling Contract) 40 hours per week -covering bank holidays and weekends – shift basis - flexible working hours
Local Egypt Bonus Scheme
Hybrid Working (2 days per week office working)
Job Grade: A12
We make health happen
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, around 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), Dublin (Europe), Miami (USA), Dubai (UAE, in partnership with OIC), Egypt and Hong Kong (China) as well as regional offices in mainland China, Singapore, the Dominican Republic, Bolivia, Panama, Guatemala and Ecuador.
Role Overview
In this role the primary goal is to evaluate and authorise clinical cases and complex medical preauthorisation. In addition to work closely with our regional CM team to leverage knowledge, capability and process.
These roles join our team of specialists who support our customers 24/7. You'll need to be flexible to work shifts that include weekends (on a rota basis).
How you’ll help us make health happen
Investigate, and respond to enquiries for complex medical authorisations and high value within certain threshold and criteria 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 claims eligibility, coverage and alternative treatments.
Works with audit and pre-authorization teams to identify and investigate any fraud or abuse.
Preparing case reports for each investigation performed. Keeping record of daily activity for monthly reporting.
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.
What you'll need:
Previous medical insurance experience is mandatory
Clinician in an associated field such as pharmacist, physiotherapy
Strong communication skills with excellent English
Can work shifts in a 24/7 operating environment on a rota basis which includes weekends.
Experience within a customer facing environment
Good telephone manner, as this will be taking customer calls
Excellent medical background with practical medical experience.
Experience with decision making in a clinical setting
Strong analytical skills are essential
Knowledge of clinical billing and coding is an advantage
Why Bupa?
We’re a health insurer and provider. With no shareholders, our customers are our focus. Our people are all driven by the same purpose – helping people live longer, healthier, happier lives and making a better world. We make health happen by being brave, caring and responsible in everything we do.
We encourage all of our people to “Be you at Bupa”, we champion diversity, and we understand the importance of our people representing the communities and customers we serve. That’s why we especially encourage applications from people with diverse backgrounds and experiences.
Bupa takes pride in being a Level 2 Disability Confident Employer and will aim to offer an interview/assessment to disabled applicants who best meet the minimum criteria for the role. We’re committed to ensuring you’re treated fairly during the recruitment process and offer reasonable adjustments to anyone who may benefit from accommodations to the recruitment process.
If you require information regarding this role in an alternative format, please email: careers@bupa.com
Time Type:
Full time
Job Area:
Administration
Locations:
Egypt - Cairo