Key Responsibilities
Clinical Complaints handling. Process responsible for delivery of the final clinical reviews including activating key stakeholders (clinical and non-clinical) as needed and support complaints team through the most relevant format whether that is a face-to-face meeting, telephone or written communication. Attending regular meetings with Complaints department in the continued development and improvement of the linked processes.
Clinical underwriting and Medical risk assistance providing specialist clinical advice and support through the most relevant format whether that is a face-to-face meeting, telephone or written communication using extensive subject knowledge whilst working independently.
Attending regular meeting with underwriting department and with Private Client Group key stakeholders in the continued development and improvement of the linked processes.
Accountable for Clinical Medical policy review, assist in Support Point update, and support the BI policy development if needed.
Further accountabilities shared with the Clinical team:
In a professional and approachable manner, proactively deal with all types of medical inquiries from internal and external customers and provide clinical advice and complete support through the most relevant format whether that is a face-to-face meeting, telephone or written communication in relation to all often complex queries and issue resolution with limited management authority whilst working independently with minimal guidance using their extensive subject knowledge.
Using extensive knowledge and through evidence-based reference, evaluate medical information and determine the clinical eligibility for medical care, and maintaining both best practice and cost-effectiveness.
Identify, develop and comply with quality criteria for the clinical case and claims management and the business in general including the registration of complaints and ensure appropriate feedback is given and corrective action is taken.
Support, participate and contribute to business wide projects and initiatives including to plan and perform business relevant presentations to internal and external parties.
Ensuring that the electronic records reflect up to date medical information, clinical decision, advice, and communications with the member.
Ideal Candidate
Registered within a medical specialty, a licensed doctor with minimum five years clinical experience and three years experience in the insurance industry insurance business - ESSENTIAL. Will be required to comply and meet BUPA BGMU standardized learning development and learning for clinicians.
Previous experience, preferably in international private medical insurance or in an administrative capacity within a hospital environment.
Strong Arabic and English, both written and verbal. Additional languages would be an advantage.
Strong numerical skills and the ability to understand and produce financial reconciliations
Knowledge of private hospital industry and its pricing and quality dynamics.
Track record of achieving targets with a consistent high level of quality.
Ability to liaise with different teams and at different management levels
Good team player. Willing to support and advise colleagues
Actively search for and attend relevant training courses.
Flexible – ability to learn new skills and adapt to changing working practices/dynamics and environment and demonstrate a willingness to change.
Flexible working hours.
Ability to be empathetic and view issues from the customers perspective while maintaining a professional outlook
Skilled in communication, able to liaise with doctors, hospitals, brokers, members, and colleagues
Ability to work under pressure and on his/her initiative.
Good influencing skills with confidence and ability to challenge appropriately
PC literate
Organises own work effectively, works independently with minimal guidance.
Effective decision making and investigatory skills
Previous experience, preferably in international private medical insurance or in an administrative capacity within a hospital environment.
Strong Arabic and English, both written and verbal. Additional languages would be an advantage.
Strong numerical skills and the ability to understand and produce financial reconciliations
Knowledge of private hospital industry and its pricing and quality dynamics.
Track record of achieving targets with a consistent high level of quality.
Ability to liaise with different teams and at different management levels
Good team player. Willing to support and advise colleagues
Actively search for and attend relevant training courses.
Flexible – ability to learn new skills and adapt to changing working practices/dynamics and environment and demonstrate a willingness to change.
Flexible working hours.
Ability to be empathetic and view issues from the customers perspective while maintaining a professional outlook
Skilled in communication, able to liaise with doctors, hospitals, brokers, members, and colleagues
Ability to work under pressure and on his/her initiative.
Good influencing skills with confidence and ability to challenge appropriately
PC literate
Organises own work effectively, works independently with minimal guidance.
Effective decision making and investigatory skills
About The Company
Bupa purpose is longer, healthier, happier lives.
As a leading global health and care company, we offer health insurance, medical subscription and other health and care funding products; we run care homes, retirement and care villages, primary care, diagnostic and wellness centres, hospitals and dental clinics. We also provide workplace health services, home healthcare, health assessments and long-term condition management services. We have 32M customers globally. With no shareholders, we invest our profits to provide more and better healthcare and fulfil our purpose. We employ 86,000 people, principally in the UK, Australia, Spain, Poland, New Zealand and Chile, as well as Saudi Arabia, Hong Kong, India, and the USA.
We have grown significantly, particularly through 2013 to 2015, when we accelerated execution of our 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.
Bupa Strategic Framework
Our strategy has three pillars: Customers, People, Performance. It puts our customers front and centre in the context of today digital age. As a service organisation, everything we do for our customers relies on our people and partners, so being a place where people love to work is critical to our success. This, combined with disciplined risk and capital management, is how we will deliver strong and sustainable performance. We are looking for individuals who share in our values and this strategy, and are capable of delivering outstanding results for the business.
Bupa Global
Bupa Global provides products and services worldwide to people who want access to premium health and care at home or as they study, live, travel or work abroad. We provide international health insurance, travel insurance and medical assistance to individuals, small businesses and global corporate customers all around the world.
Bupa Global has over 1,800 employees and has offices in London and Brighton (UK), Miami (USA), Copenhagen (Denmark), Hong Kong (Greater China), and Dubai (UAE), as well as in Egypt, Mexico, the Dominican Republic, Bolivia, Panama, Guatemala and Ecuador. Bupa Global is currently organised around five regional hubs: Bupa Global Africa, India & Middle East; Bupa Global Greater China; Bupa Global Latin America; Bupa Global North America and Bupa Global Europe.
Medical Specialist Advisor
Medical Specialist Advisor
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