Care Coordinator

2 days ago


مصر, Egypt Bupa Global Full time

Job Introduction
**_
Care Coordinator_**

**_Permanent, 35 hours a week_**

**_Shift based in a 24/7 operating model including weekends and public holidays_**

**_Office based - Cairo_**

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 and making a better world.

**The 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).

Main Responsibilities
- 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.
- 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.
- 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.
- Previous medical insurance experience is mandatory
- Clinical experienced
- Experience healthcare setting in an associated field such as pharmacist, physiotherapy would be an advantage
- 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

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 you are invited to an interview, a member of the resourcing team will be able to advise you on what to expect. This will vary in region, but will likely include an initial phone or digital interview, followed by one or more of the following depending on the role: Core capability interview; Technical/function specific interview; Online profiling assessment; Presentation, written task, role play; Assessment centre.


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