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Job Description
Enhancing of CX of clients concerned with non-approved cases and Referral management cases through applying of PA decision review, case management process, direct contact with clients, and coordination with both internal and external stakeholders within a defined time frame and restrictions of TOB. More-over, pinpoint and tackle the root causes that result in the non-approval to enhance the volume and quality of the non-approval decisions.
Manage MCU Recovery\\ Referral work list cases:
- Review cases appearin on Aramco MCU list either diverted from PA work list or created by other stake holders to ensure the quality of the decision as well as the application of TOB guidance by PA users / automated system.
- Review referral cases to proceed with allocting the requested services and issuning the needed referral document when requested.
- Good judgment, adaptive business intuition, and strong teamwork skills to work well with team members
Communications with internal and external stakeholders:
- Direct interaction with clients through phone calling for explanation of decision, process and obtain necessary data (for outpatient cases only), to be highlighted to mangers\\Sr. managers in the recovery team.
- Respond to the internal stakeholders' queries via CMT\\Emails.
- To perform oubound calls for members experience assessment.
- To communicate with patients in NPR cases when needed.
- Capability to work within the frame of legal and operational requirements which defines the guidelines of interaction with clients either imposed by Bupa, regulators or the client institution.
Actively share in analysis, and problem solving:
- Coordinate with data analysts and use simple problem solving and root cause analysis tools to monitor any deviation in the breakdown, volume and origin of cases managed on the recovery list.
- Recording of the done transactions in platforms\\excel sheets on daily basis
Skills
- Strong logical, analytic, Presentation, assessment and interpretation skills
- Advanced communication and negotiation skills.
- Basic to intermediate knowledge of Microsoft Office
- Able to multitask and work well under stress.
- Strong troubleshooting, problem-solving and analytical skills, excellent follow up skills.
- Ability to effectively prioritize and execute tasks in a high-pressure
- A medical science degree (pharmacology, clinical laboratories, Nursing., physiotherapy…etc.)
- Any degree/ training in Excel, Data Management and Dashboards, Business Writing, Client Management shall be considered
Job Details
Preferred Candidate
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.
