The primary goal is to evaluate and authorise clinical cases and complex medical pre-authorisations. In addition to working closely with our UK domestic business to leverage knowledge, capability and process.
Responsibilities
* To investigate, and respond to enquiries for complex medical pre-authorization and high-value claims from different internal and external stakeholders including but not limited to members, providers, service providers and intermediaries in the appropriate method, in line with Bupa Global policy and management style
* Ensure the correct interpretation of Bupa Global's policies and rules, using the appropriate coding system to process the data and information accurately.
* Identify opportunities to reduce future claim expense for Bupa Global
* Proactively negotiate medical cost based on evidence to achieve either reduced cost to the business
* Proactively identify fraud and/or abuse and reports to appropriate parties
* Oversee member's progress and monitor the discharge plan drafted
* Prepare documents and reports required for internal and external stakeholders in the scope of case coordination activities and/or data collections
* Input clinical information into computer database, under the supervision of regional case manager
* Assist Regional Contracting Manager with projects on an ad-hoc basis
Qualifications
* Bachelor Degree or above in healthcare or related discipline
* Doctor or RN experience with speciality (local or overseas) is preferred, OR
* At least 2 years of solid experience in utilization review or case management in IPMI environment
* Knowledge of coding system is a must
* 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 focused and able to place customer's health and benefit in the first priority
* Understand the business commitment to meet deadlines and turnaround times
* Proficient communication skills in English
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