إرفاق
وصف الوظيفة
To execute and complete specific deliverables and activities to analyse and validate statistical data using advanced analysis to identify and quantify impacts on medical cost trends with the objective of providing the highest appropriate quality and cost-effective care for its members
Healthcare Dala Analysis:
· Design data models that integrate patient data from multiple sources to create complete views of health data
· Members health risk segmentation and chronic cases profiling (e.g., chronic disease, cancer, hepatic disease, renal failure) to be of value in cost savings and, customer retention.
· Conduct feasibility and impact studies for the planned projects
· Publish monthly reports for top providers for all data about, high value drivers, high value medications, and high value cases.
Business opportunities:
· Develop quantified business waste for outlier behavior or billing irregularities
· Identify and eliminate inefficiencies to create a portfolio of work leading to savings.
· Share savings opportunities from recoveries or prevention and monitor provider inflation according to medical conditions and benefits
· Validate savings before and after the executed actions by measuring the realized impact of the cost management activities
Data Management:
· Apply advanced categorization of services with standardized and concise mapping.
· Manage Initiation and maintenance of new enhancement segmentation for services and medical conditions
· Ensure proper validation of doctor names in the data, specialties, modifying and validating of the unified service coding process
Providers Commercial Terms:
· Develop and review terms with providers within Bupa’s network as well as prospective providers to introducing them into the network.
· Create and implement new templates for price comparison and its impact studies, considering all the variations in the providers’ billing, and the services complexity.
Analysis Transformation:
· Collaborate with the different business units and functions in order to execute the assigned objectives related to Big data projects and digital enhancements, transformations and implementations
· Interpret and validate data to be incorporated into advanced analytics and ML models.
Provider’s Inflation Monitoring:
· Monitor medical inflation figures with ongoing effective oversight of all potential hits that may affect cost on short term and long term perspectives.
· Provide information about various costs trends, initiatives being taken in operations and monitor the progress against each initiative and exceptions that require actions.
المهارات
· 3 - 5 years experience preferrably in healthcare/ health insurance
· Bachelor degree preferrably with medical background
· Intermediate to advanced skill level with MS Excel and PowerPoint
· Data analysis including healthcare claims data manipulation
· Ability to interpret both high level and detailed view of the data
تفاصيل الوظيفة
المرشح المفضل
Bupa Arabia
Bupa Arabia is a healthcare insurance company based in the Kingdom of Saudi Arabia. We are an associate business of Bupa Group, which is a global healthcare company with an international reach that extends across multiple business operations, practices, and resources.
Founded in October 1997, Bupa Arabia was initially established through a partnership between Bupa Global International and Nazer Group, with the key focus to provide health insurance services with high quality and competitive prices, while ensuring a distinctive experience for customers. Bupa Arabia has since evolved into a fully Saudi-owned and operated company. Our transformation from a joint venture into a publicly traded company on the Saudi Stock Exchange occurred in 2008, as we made 40% of our shares available to the public during our Initial Public Offering (IPO).
As a subsidiary of the global Bupa Group, we draw upon international expertise while maintaining a profound understanding of local healthcare requirements and regulations. This allows us to offer comprehensive healthcare insurance solutions tailored to the unique needs of the Saudi Arabian market.
Bupa Arabia prides itself on its commitment to the wellbeing and development of its employees, providing them with the same standard of care, support, and professionalism that it expects to be delivered to its customers.
Our core values shape every aspect of our work and culture:
Commit – Own it with accountability and urgency.
Collaborate – Win together through cross-functional synergy.
Care – Put people first, both employees and customers.