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Global Medical Case Manager

Employer
Bupa Global
Location
Brighton, East Sussex
Salary
Competitive
Closing date
16 Dec 2020

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Sector
Finance, Insurance , Healthcare, Nursing
Function
Operations
Contract Type
Permanent
Hours
Full Time

Job Details

The Global Case Management Consultant will join our global team of specialists who support individual case management of medical cases to ensure quality care. The roles are part of a business expansion and focus on regional teams to provide medical assistance to our policy holders. This exciting role will be flexible in working arrangement with a split between office (Brighton) and homeworking. The role supports core hours of operation Monday to Friday and between 7am and 7pm.

 

 

 

This role ensures that all parties (broker, company, provider, service partner, colleagues) involved are kept up to date on the progress of authorisation and case details. The Global Case Management Consultant will also have an integral role in the current case management process, as well as the claims audit and on-site case review.

 

 

 

Responsibilities

 

  • Investigate, and respond to enquiries for complex medical pre-authorization and high value claims from different internal and external shake holders including but not limited to members, providers, service providers 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 the decision of requests 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-authorisation teams to identify and investigate any fraud or abuse.
  • Prepare case reports for each investigation performed. Keeps records of daily activity for monthly reporting.
  • Identify opportunities to reduce future claim expense for Bupa Global and to pro-actively provide relevant information to Healthcare Management Team.
  • Proactively negotiate medical costs and/or medical treatment to achieve both reduced cost to the business and most appropriate treatment for the member where appropriate.
  • Develop and maintain an up to date and accurate knowledge of appropriate Bupa products, policies and initiatives in order to ensure that all queries are answered accurately.
  • Supports Bupa’s global medical teams to provide provider/specialist recommendations, estimation of medical costs, appointment booking, support case management, etc.
  • Achieve departmental and individual KPIs and keep individual CPD up to date
  • Takes responsibility for the logging of all communications whether written or verbal as well as complaints on the customer database, ensuring it is up to date and as accurate as possible.
  • To comply with and take into account any requirements from the local regulators and/or any applicable local regulatory requirements
  • Handles complaints and undertakes root cause analysis to enable goal orientated future solutions
  • Triage of cases to define whether onward referral to one of our specialist partners is appropriate

The ideal candidate:

 

  • Bachelor Degree or above in healthcare or related discipline
  • Doctor or RN experience with speciality (local or overseas) is preferred OR excellent medical background with practical medical experience.
  • Superior customer service and negotiation skills.
  • Solid experience in utilisation review or case management in IPMI environment.
  • Knowledge of medical coding systems
  • Excellent knowledge of Microsoft Word® and Microsoft Excel® is a must
  • Excellent interpersonal skills and ability to work with a team is a must
  • Excellent analytical and critical thinking skills
  • Respects diversity and embraces cultural difference
  • Highly customer focussed and able to place the customer’s at the heart of all their decision making.
  • Prepared to visit patients at healthcare providers premises in various locations
  • Understand the business commitment to meet deadline and turn-around times
  • Excellent record keeping and reporting skills, with the ability to deliver reporting requirements on time.
  • Good judgement and ability to prioritise workflow according to business needs
  • Proficient communication skills in English

     

Company

Bupa’s purpose is longer, healthier, happier lives and making a better world.

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 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.

Diversity and Inclusion 

 

Bupa is committed to making sure that every applicant is assessed solely on personal merit and qualifications. We actively celebrate the diversity of our colleagues and provide an inclusive environment so you can bring your true self to Bupa. We’ll make sure you are treated fairly regardless of disability or circumstance. That’s why we’re happy to offer reasonable adjustments as part of our recruitment process to anyone that needs them.  

Whether you’ve found your feet or are discovering a new path.  

Welcome to a place that celebrates you.  

This isn’t where you've been.   

This is where you're going.  

This is what we have belief in. 

 

We think you would enjoy life with us too – here are a few reasons why:

  • we have a happy, fun and productive environment
  • we support and appreciate our people
  • you'll work with highly motivated colleagues
  • there are lots of opportunities to volunteer for local community projects
  • we offer discounts on many of our products and services to help you take care of your health

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Company info
Website
Telephone
01273866157
Location
Victory House
Trafalgar Place
Brighton
East Sussex
BN1 4FY
United Kingdom

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