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Job Description
Role Purpose:
Ensure timely responses and proper case management of all queries, requests, and complaints through proper follow up in alignment with the Service Operations Support policies to resolve cases for relationship managers and ultimately serve our customers with the highest standards in line with the overall company's service strategy.
Accountabilities:
1- End to End Case Management:
- Work with sales management team on target alignment to ensure on-time fulfillment delivery as per BUPA service and quality standards.
- Handle all cases received from RM's with high quality and ensure proper resolution within the KPI's.
- Liaise with required functional teams to resolve cases escalated by RM's.
- Daily track/record of all pending and closed cases and monitor resolution time.
- Establish effective control & quality assurance in all interface data processes
- Collaborate feedback with the sales team for continuous improvement.
2- Complaint management:
- Review and resolve complaints that have been escalated by RM's
- Record the complaints and share with the Quality team.
- Discuss medical Pre-Auth and claims statement rejections with sales/Provider relations in order to collaborate in aligning customer/provider practices with BUPA policies
3- Process Enhancements:
- Support process improvements in the Pre-Auth and Claims processes with Sales in system enhancements and --company performance initiatives to help develop the most efficient processes.
- Continuously strive to improve the customer Pre-Auth and Claims experience by participating in focus groups to identify ways to improve the process
4- Data Analysis:
- Assist in conducting database analysis and use results to improve processes and KPI’s.
- Support in the creation of Dashboards for all Back Office activities and circulate them internally
5- Commercial and Ex-Gratia Approval:
- Review all commercial and Ex-Gratia approval requests from RM’s and escalate to the authorized person in the authority matrix.
- Process the approval through CAESAR while liaising with Pre-Auth and update the RM on the outcome.
- Maintain and update the commercial budget records
Skills
Experience Fields:
1- Good analytical skills and planning capabilities
2- Multi-Cultural with very good communication skills
3- Deep understanding of CCHI & regulations
4- Knowledge in the insurance and medical terminology is a major advantage.
5- Service mindset
Education
Nurse - Pharma
