Job Description:
Global Case Manager
Brighton – Victory House
Hybrid
Full time ( 35 hours per week)
From £45,400 depending on experience
We make health happen
The Global Case Management Consultant will report to the Clinical Service Manager with the primary goal of individual case management of medical cases as specified by
the business to ensure quality care with special focus on balancing financial
savings. This role ensures that all parties (broker, company, provider, service
partner, colleagues) involved are kept up to date on the progress of authorisation
and case details. The Global Case Management Consultant will have an integral
role in the current case management process, as well as the claims audit and
on-site case review.
This role is part of a global case management operation with the core operating hours between 07:00 - 19:00 Monday to Sunday (5 out 7 days). Weekends will be occasional and a on shift rota basis. There may also be work outside those hours to support more complex cases.
How you’ll help us make health happen:
1. Investigate, and respond to enquiries for complex medical pre-authorization and high value claims from different internal and external stake holders including but not limited to members, providers, service providers and intermediaries in the appropriate method, in line with Bupa Global policy and management style
2. Pro-actively contact members, providers, service partners and intermediaries via telephone, email, fax and letter to advise on the decision of requests and fully explain benefit entitlement to all parties.
3. 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
4. Liaise with Global clinical staff to interpret condition and treatment to the rules and regulations of Bupa Global
5. Liaise with all areas of the business to assist with resolving enquiries, such as claims eligibility, coverage and alternative treatments.
6. Works with audit and pre-authorisation teams to identify and investigate any fraud or abuse.
7. Prepare case reports for each investigation performed. Keeps records of daily activity for monthly reporting.
8. Identify opportunities to reduce future claim expense for Bupa Global and to pro-actively provide relevant information to Healthcare Management Team.
9. Proactively negotiate medical costs and/or medical treatment to achieve both reduced cost to the business and most appropriate treatment for the member where appropriate.
10. 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.
11. Supports Bupa’s global medical teams to provide provider/specialist recommendations, estimation of medical costs, appointment booking, support case management, etc.
12. Achieve departmental and individual KPIs and keep individual CPD up to date
13. Takes responsibility for the logging of all communications whether written
14. or verbal as well as complaints on the customer database, ensuring it is up to date and as accurate as possible.
15. To comply with and take into account any requirements from the local regulators and/or any applicable local regulatory requirements
16. Handles complaints and undertakes root cause analysis to enable goal orientated future solutions
17. Triage of cases to define whether onward referral to one of our specialist partners is appropriate
Key Skills / Qualifications needed for this role:
18. Bachelor Degree or above in healthcare or related discipline
19. Doctor or RN experience with speciality (local or overseas) is preferred.
20. OR
21. Excellent medical background with practical medical experience.
22. Superior customer service and negotiation skills.
23. At least 2 years of solid experience in utilisation review or case
24. management in IPMI environment.
25. Knowledge of coding systems
26. Excellent knowledge of Microsoft Word® and Microsoft Excel® is a must
27. Excellent interpersonal skills and ability to work with a team is a must
28. Excellent analytical and critical thinking skills
29. Respects diversity and embraces cultural difference
30. Highly customer focussed and able to place the customer’s at the heart of all their decision making.
31. Prepared to visit patients at healthcare providers premises in various locations
32. Understand the business commitment to meet deadline and turn-around times.
33. Excellent record keeping and reporting skills, with the ability to deliver reporting requirements on time.
34. Good judgement and ability to prioritise workflow according to business needs.
35. Proficient communication skills in English
Benefits:
36. •25 days holiday, increasing through length of service, with option to buy or sell
37. •Bupa health insurance as a benefit in kind
38. •An enhanced pension plan and life insurance
39. •Onsite gyms or local discounts where no onsite gym available
40. •Various other benefits and online discounts
At Bupa we adhere to a structured framework when awarding any changes to salary. We believe this creates a fair and consistent approach for all colleagues looking to grow or change role. For more guidance please click HERE.
Before you apply for a vacancy, please ensure your job history on your workday profile is up to date with all your career history and achievements. This will mean the Recruitment team have all the relevant information they need to review your application.
Please be aware that if you’re successful in securing this role there may be changes to your notice period and other terms and conditions, your recruiter will be able to advise what this means for you during your application.
Why Bupa?
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 Sukoon), Egypt and Hong Kong (China) as well as regional offices in mainland Singapore, the Dominican Republic, Bolivia, Panama, Guatemala and Ecuador.
Time Type:
Full time
Job Area:
Business Development
Locations:
Victory House, Brighton