Provider Services Consultant
4 days ago
Main Responsibilities
- Respond to all relevant incoming correspondence and queries from our internal departments relevant to providers claims. This will be as per the Claims department key performance indicators, which state turnaround time and quality standards.
- Re-assessing and rectifying simple provider paid 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.
- Ensure the correct interpretation of Bupa Globals’ 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 providers as stated in our aims and mission statement. The job holder will need to make customer/provider focused actions based on effective decision-making skills. This will also include excellent internal customer/provider service, with continuous contribution given towards achieving individual, team and department goals and objectives.
- To contribute to the continuous development of the claims process by identifying opportunities for product development and process improvement.
- Suspend claims that require further investigation in order to resolve appropriately to ensure the correct continuation of processing within agreed timeframes and standards in suspend process.
- Logging claims on the system under correct members’ registrations, when needed.
- Recognise and challenge possible fraudulent information and proactively seek to clarify and resolve using best method of communication and initiative.
- To comply with and abide by the requirements of the FCA, Egyptian Financial Supervisory Authority or any other relevant regulator at all times.
- Work on shift basis according to business need.
- Use agreed levels of authority and previous experience to make effective business decisions.
- Take ownership of the enquiries and liaise between departments to provide a ‘seamless service’ to providers.
- Support new team members throughout their learning curves.
- Ensure that the team objectives are met throughout the year
- Liaise closely with the Healthcare Management Team who own/manage the contracts with providers to ensure relevant provider behaviour concerns or general feedback is given to help improve overall provider relationships between all parties.
- Able to demonstrate that you pay due regard to customers, providers and treat them fairly by:
- being able to explain the impact that your role and actions have on the fair treatment of providers and customers.
- being able to explain the potential implications for providers and customers who are not treated fairly by you or others.
- making the fair treatment of customer/provider central to all that you do.
- Always seeking to be competent to do your job e.g., by completing all compulsory regulatory training on time to ensure that you have all the necessary knowledge and skills
- Experience in a position with a medical background is desirable
- Background in the global health insurance market, or relevant transferable skills and knowledge from other financial services industries such as Life Insurance, Retail, Commercial or Investment Banking and Wealth Management
- Previous experience of a complex and multi skilled customer/provider facing or claims roles are highly desirable.
- A track record of achieving and exceeding productivity and quality targets
- Highly customer focused.
- 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.
**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**:
If
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