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    Global Case Manager - Doral, United States - Bupa

    Bupa
    Bupa Doral, United States

    3 weeks ago

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    Description
    Before submitting your application, you should read our privacy notice

    to understand how Bupa will use, store and share your information.
    For Australia or New Zealand candidates - Before submitting your application, you should read our privacy notice

    to understand how Bupa will use, store and share your information.
    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.

    The primary goal is to evaluate and authorise clinical cases and complex medical preauthorisation and support our members during their treatment journey.


    How you'll help us make health happen:

    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 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 shake holders 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 in ad-hoc basis

    Key Skills / Qualifications needed for this role:
    Bachelor Degree or above in healthcare or related discipline (Doctor or Registered Nurse) experience with speciality (local or overseas) is preferred
    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 focussed and able to place customer's health and benefit in the first priority.
    Understand the business commitment to meet deadline and turn-around time
    Proficient communication skills in English

    Time Type:
    Full time


    Job Description:
    Global Case Manager
    Hong Kong
    Hybrid (up to 3 days WFH)
    Permanent
    Full Time
    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.

    The primary goal is to evaluate and authorise clinical cases and complex medical preauthorisation and support our members during their treatment journey.


    How you'll help us make health happen:

    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 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 shake holders 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 in ad-hoc basis

    Key Skills / Qualifications needed for this role:
    Bachelor Degree or above in healthcare or related discipline (Doctor or Registered Nurse) experience with speciality (local or overseas) is preferred
    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 focussed and able to place customer's health and benefit in the first priority.
    Understand the business commitment to meet deadline and turn-around time
    Proficient communication skills in English

    Time Type:

    Full time Job Area:

    Delivery and Operations Locations:
    The Quayside
    About Us

    Be at the heart of helping people live longer healthier, happier lives and making a better world . We employ more than 80,000 people globally who are making this a reality.

    If you've got the belief, the drive and the talent to help us in our ambition then we'd like to hear from you.

    Wherever you work, one thing stands out about Bupa people. Our customers are our passion – they're at the heart of our positively different culture of care.

    At Bupa you'll be challenged, you'll be encouraged to innovate, and collaborate with colleagues who are committed to delivering exceptional experiences.

    We trust, respect and consider everyone, knowing your difference will make the difference.
    Get In Touch


    Please introduce yourself to our recruiters and we'll get in touch if there's a role that sounds like a good match.

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