Claims Assessor - Temporary

• Claims Assessor
  About Bupa
  Bupa is a leading international healthcare group that provides health
  insurance and medical subscription products and runs care homes, retirement
  villages, hospitals, primary care centres and dental clinics around the world.
  We also provide workplace health services, home healthcare, health assessments
  and long-term condition management services. We have over 22m customers in ‎190
  countries. With no shareholders, we invest our profits to provide more and
  better healthcare and fulfil our purpose. We employ more than ‎70,000 people,
  principally in the UK, Australia, Spain, Poland, New Zealand and Chile, as
  well as Saudi Arabia, Hong Kong, India, Thailand, and the USA.
  We have grown significantly, particularly in ‎2013 when we accelerated
  execution of our Bupa ‎2020 strategic vision. We are similar in revenue and
  profit to Marks & Spencer, and larger than Heinz in revenue. Because Bupa does
  not have shareholders it does not have a listing, but if it did it would be in
  the FTSE ‎100. Bupa is not a mutual or a charity but a company limited by
  guarantee that seeks to maximise its profits in order to fulfil its purpose.
  With customers in virtually every country in the world and ‎70% of its revenues
  now generated outside the UK, Bupa is a truly international organisation.
  Our people
  Bupa believes that the growth and performance of our leaders and our people is
  the single biggest pathway to fulfilling our purpose (longer, healthier,
  happier lives) and delivering Bupa's ‎2020 goals. We have a leadership
  framework called "Bupa Leaders Are" which sets out what great leadership looks
  like at Bupa. Leaders are called upon to grow themselves, to grow others, to
  grow the business, to improve the health of the world. We are looking for
  individuals who are capable of delivering extraordinary business outcomes.
  Bupa Global
  Bupa Global is the worldwide Bupa business. We provide products and services
  in ‎190 countries for globally minded and mobile people who want the most
  premium coverage and access to the best healthcare anytime, anywhere in the
  world, whether at home or when studying, living, travelling or working abroad.
  We have over ‎1,700 employees working for our circa 2million customers around
  the world. We have a medical advice line staffed by a team of experienced,
  multi-lingual advisers to offer our customers support ‎24 hours a day, every
  day. We also have an emergency medical team of doctors on hand as an optional
  benefit to organise emergency assistance and evacuations.
  Bupa Global has offices in London and Brighton (UK), Miami and Philadelphia
  (USA), Copenhagen (Denmark), Hong Kong (Greater China) as well as in Egypt,
  Mexico, the Dominican Republic, Bolivia, Panama, Guatemala and Ecuador and is
  currently organised around three regional hubs: Bupa Global Business Unit
  (incorporating Europe, Middle East and Greater China), Bupa Global Latin
  America and Bupa Global North America.

Purpose
To take responsibility for entire claims assessment and claims missing
information requests, process including benefit explanation.
Freedom of action/Dimensions
There are established procedures which the job holder must adhere to with some
scope for change on an individual claims basis as and when these arise. This
must be in line with direction and authorisation, when required from the Team
Leader. This is as per BUPA International policies and guidelines and current
legislation.
Claim payment authorisation differs according to the country of treatment &
ranges from ‎4000 to ‎10,000 GBP
Dimensions:
* To ensure fair and accurate benefit spend of the claims department
* The job holder is accountable to the customer and must act in a way that reflects Bupa Global's values by delivering an exceptional service
Roles are on a shift rotation basis including weekends
Reports to
Claims & Provider Service Manager
Manages
NA
Level
‎5.2
Location
Bupa Egypt office - Cairo
Accountabilities
* Inputting claims into the computer system with a high degree of accuracy.
* To action any claim related query in line with Bupa Global policy and style.
* To obtain all necessary information on claims for the purpose of complete processing, including liaison with internal departments, using the following methods: telephone or e-mail. This may also include gaining information to research further details required to assess a claim.
* Respond to all relevant incoming correspondence and queries from our internal departments. This will be as per the Claims department key performance indicators, which state turnaround time and quality standards.
* Ensure the correct interpretation of BUPA Internationals' policy and rules, using the correct compatible combinations of codes for accurate processing of data, in accordance with our service standards and customer expectations.
* To provide excellent customer service for our members as stated in our aims and mission statement. The job holder will need to make customer focused actions based on effective decision making skills. This will also include excellent internal customer service, with continuous contribution given towards achieving individual, team and department goals and objectives.
* To contribute to the continuous development of the claims process by identifying opportunities for product development and process improvement.
* Suspend claims that require further investigation in order to resolve appropriately to ensure the correct continuation of processing within agreed timeframes and standards in suspend process.
* Logging claims on the system under correct members' registrations, when needed.
* Translate Arabic documents to English when requested by other Bupa International departments.
* Recognise and challenge possible fraudulent information and proactively seek to clarify and resolve using best method of communication and initiative.
* To Comply with and always abide by the requirements of the Egyptian Financial Regulatory Authority
* Work on shift basis according to business need.
Bupa Global core
Capabilities
* Leading - Foundation
* Working effectively - Foundation
* Knowing our business - Foundation
* Loved by customers - Foundation
Performance indicators
* Productivity
* Quality
* Committing to the SLAs
* NPS
Delivering fair outcomes for consumers and Understanding your regulatory
obligations
* Put fair treatment of customers at the heart of what you say and do. Be courageous and speak up if you believe our products or services do not deliver what we have led our customers to expect .
* Be accountable and take ownership for ensuring you are familiar with all regulatory requirements that fall within the remit of your role and comply with them at all times. Seek guidance if you need support understanding your regulatory requirements. Notify, without delay, any potential or actual breach of regulation.
* To maintain governance and control requirements, ensuring all internal governance requirements are met, including full compliance with all policies, audit actions, monitoring actions and risk appetite.
Academic/
Professional qualifications
* The jobholder should be educated to degree level or equivalent
* The jobholder should have a medical background
* The jobholder must be fluent in written and spoken Arabic & English
* A third language other than English and Arabic is an advantage.
* Good keyboard and IT skills - Interpret written data and translate to the appropriate codes to be accurately input onto the in house computer system
* Numerate - Be able to understand numerate information presented on invoices from providers and be able to perform calculations to ensure the accuracy of the claims information
* Good problem solving and prioritisation skills, with close attention to detail
* Ability to work to targets under pressure
* Ability to work well alone, as well as part of a Team
A knowledge of worldwide currencies and geographical locations is desirable
Ideal experience and delivered performance
* Experience in a position with a medical background is desirable
* Background in the global health insurance market, or relevant transferable skills and knowledge from other financial services industries such as Life Insurance, Retail, Commercial or Investment Banking and Wealth Management
* A track record of achieving and exceeding productivity and quality targets
* Highly customer focussed
* Excellent interpersonal, communication and influencing skills are required with emphasis on achieving results and successful outcomes.
Time Type:
Full time