Claims Assessor

**Claims Assessor**

**_About Bupa _**

Bupa is a leading international healthcare group that provides health insurance and medical subscription products and runs care homes, retirement villages, hospitals, primary care centres and dental clinics around the world. We also provide workplace health services, home healthcare, health assessments and long-term condition management services. We have over 22m customers in 190 countries. With no shareholders, we invest our profits to provide more and better healthcare and fulfil our purpose. We employ more than 70,000 people, principally in the UK, Australia, Spain, Poland, New Zealand and Chile, as well as Saudi Arabia, Hong Kong, India, Thailand, and the USA.

We have grown significantly, particularly in 2013 when we accelerated execution of our Bupa 2020 strategic vision. We are similar in revenue and profit to Marks & Spencer, and larger than Heinz in revenue. Because Bupa does not have shareholders it does not have a listing, but if it did it would be in the FTSE 100. Bupa is not a mutual or a charity but a company limited by guarantee that seeks to maximise its profits in order to fulfil its purpose. With customers in virtually every country in the world and 70% of its revenues now generated outside the UK, Bupa is a truly international organisation.

Our people

Bupa believes that the growth and performance of our leaders and our people is the single biggest pathway to fulfilling our purpose (longer, healthier, happier lives) and delivering Bupa’s 2020 goals. We have a leadership framework called “Bupa Leaders Are” which sets out what great leadership looks like at Bupa. Leaders are called upon to grow themselves, to grow others, to grow the business, to improve the health of the world. We are looking for individuals who are capable of delivering extraordinary business outcomes.

Bupa Global

Bupa Global is the worldwide Bupa business. We provide products and services in 190 countries for globally minded and mobile people who want the most premium coverage and access to the best healthcare anytime, anywhere in the world, whether at home or when studying, living, travelling or working abroad. We have over 1,700 employees working for our circa 2million customers around the world. We have a medical advice line staffed by a team of experienced, multi-lingual advisers to offer our customers support 24 hours a day, every day. We also have an emergency medical team of doctors on hand as an optional benefit to organise emergency assistance and evacuations.

Bupa Global has offices in London and Brighton (UK), Miami and Philadelphia (USA), Copenhagen (Denmark), Hong Kong (Greater China) as well as in Egypt, Mexico, the Dominican Republic, Bolivia, Panama, Guatemala and Ecuador and is currently organised around three regional hubs: Bupa Global Business Unit (incorporating Europe, Middle East and Greater China), Bupa Global Latin America and Bupa Global North America.

**_Purpose _**

To take responsibility for entire claims assessment and claims missing information requests, process including benefit explanation.

**_Freedom of action/Dimensions _**

There are established procedures which the job holder must adhere to with some scope for change on an individual claims basis as and when these arise. This must be in line with direction and authorisation, when required from the Team Leader. This is as per BUPA International policies and guidelines and current legislation.

Claim payment authorisation differs according to the country of treatment & ranges from 4000 to 10,000 GBP

**Dimensions**:

- To ensure fair and accurate benefit spend of the claims department
- The job holder is accountable to the customer and must act in a way that reflects Bupa Global’s values by delivering an exceptional service

Roles are on a shift rotation basis including weekends

**_Manages _**

NA

**_Level _**

5.2

**_Location _**

Bupa Egypt office - Cairo

**_Accountabilities _**
- Inputting claims into the computer system with a high degree of accuracy.
- To action any claim related query in line with Bupa Global policy and style.
- Respond to all relevant incoming correspondence and queries from our internal departments. This will be as per the Claims department key performance indicators, which state turnaround time and quality standards.
- Ensure the correct interpretation of BUPA Internationals’ policy and rules, using the correct compatible combinations of codes for accurate processing of data, in accordance with our service standards and customer expectations.
- To provide excellent customer service for our members as stated in our aims and mission statement. The job holder will need to make customer focused actions based on effective decision making skills. This will also include excellent internal customer service, with continuous contribution given towards achieving individual, team and department goals and objectives.
- To contribute to the continuous development of