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 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. Youll need to be flexible to work shifts that include weekends (on a rota basis).

Howyoullhelp 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 Globals policy and rules using the correctcompatible 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 youll 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

Werea health insurer and provider. With no shareholders our customers are our people are alldriven by the same purpose helping people live longer healthier happier lives and making a better world. We make health happen by being bravecaringand responsible in everything we do.

We encourageall ofour people to Be you at Bupawe champion diversity and we understand the importance of our peoplerepresentingthe communities and customers we weespeciallyencourage 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 theminimumcriteria for the to ensuringyouretreated fairly during the recruitment process and offer reasonable adjustments to anyone who maybenefitfrom accommodations to the recruitment process.

If you requireinformationregardingthis role inan alternative formatplease email:

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Required Experience:

IC