Global Case Manager

Global Case Manager

Location: Hong Kong

Permanent

Full time

Onsite working

We make health happen

Bupa Global is the international health insurance division of Bupa. We provide customers who want premium international coverage with products and services to access the healthcare they need anytime, around the world, whether at home or when studying, living, travelling or working abroad.

Bupa Global has offices around the world including London and Brighton (UK), Dublin (Europe), Miami (USA), Dubai (UAE, in partnership with OIC), Egypt and Hong Kong (China) as well as regional offices in mainland China, Singapore, the Dominican Republic, Bolivia, Panama, Guatemala and Ecuador.

How you’ll help us make health happen

• Identifying and seeking relevant clinical information to accurately update the patient management system and selected clinical software tools.
• To investigate, and response to enquiries for complex medical pre-authorization and high value claims from different internal and external stakeholders including but not limited to members, providers, service providers and intermediaries in the appropriate method, in line with Bupa Global policy and management style.
• Ensure the correct interpretation of Bupa Global’s policies and rules, using the appropriate coding system to process the data and information accurately.
• Identify opportunities to reduce future claim expense and negotiate medical cost based on evidence to achieve either reduced cost to the business
• Proactively identify fraud and/or abuse and reports to appropriate parties
• Evaluates outcomes of care with the interdisciplinary team by measuring intervention effectiveness with the team implementing ongoing recommendations.
• Triage all cases referred for complex case management and assistance with evacuation/repatriation by allocating cases to available global case management teams in region and monitor throughout working hours in line with agreed SLA

Key Skills/Qualifications needed for this role:

• Bachelor’s degree or above in healthcare or related discipline
• Doctor or RN experience with speciality (local or overseas) is preferred.
• Knowledge of coding system is a must
• Experience with decision making in a clinical setting
• Experience in wide range of clinical conditions
• Knowledge of the treatment pathways specific to service user requirements
• Demonstrated ability to communicate with both clinical and non-clinical personnel across all levels of an organization.
• Excellent communication, organisational and analytical skills
• Working knowledge of healthcare system and resources.
• Excellent knowledge of Microsoft Word and Microsoft Excel is a must.

Why Bupa?

We’re a health insurer and provider. With no shareholders, our customers are our focus. Our people are all driven by the same purpose – helping people live longer, healthier, happier lives and making a better world. We make health happen by being brave, caring and responsible in everything we do.

We encourage all of our people to “Be you at Bupa”, we champion diversity, and we understand the importance of our people representing the communities and customers we serve. That’s why we especially encourage applications from people with diverse backgrounds and experiences.

Bupa takes pride in being a Level 2 Disability Confident Employer and will aim to offer an interview/assessment to disabled applicants who best meet the minimum criteria for the role. We’re committed to ensuring you’re treated fairly during the recruitment process and offer reasonable adjustments to anyone who may benefit from accommodations to the recruitment process.