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Job Description
Roles & Responsibilities
As a Claims Payment Integrity Consultant you will be directly support Bupa Global s payment integrity strategy. This role will ensure the integrity of claims paid by Bupa Global by acting as a control to mitigate the payment of false claims by verifying the validity of member and provider records. This role is also to ensure that payments are made to the correct payee and bank account information as wrong payments result in a loss to the business.
Key Responsibilities:
- You will be responsible for the review and sign off of new bank account information added to SWAN where there is an
- attempt to pay a claim. This will include in network, out of network and member paid claims.
- You will be reviewing provider information for new providers who are not yet stored in the SWAN system. This will include a review, research and requesting information to establish the validity of the provider.
- You will be responsible for adding new and valid providers to the SWAN system ensuring full contact information is captured and the provider record is accurate.
- You will be responsible for the review of out of network providers already in SWAN generated via claims rules. This will include a review, research and requesting information to establish the validity of the provider.
- You will be responsible for referring none valid providers to the Counter Fraud Team where there is evidence the provider is false or did not provide the treatment. You will also be responsible for rejecting claims where you have been unable to verify the provider information.
- You will respond directly to any relevant incoming replies from our customers when they provide us with additional information related to their claims.
- You will be actively validating potential fraudulent member/provider behaviour and referring them to the counter fraud, waste and abuse team where appropriate.
- You will contribute to the cost containment approach in managing claims through following the correct claims guidelines and rules, to support our commercial goals.
- You will be actively engaging with stakeholders around the business including working closely with the Claims Fraud Validation Officers.
- Accurately maintaining and updating customer records on the customer management system.
- Ensure that records are accurately updated whenever a customer makes contact Complying with all regulatory and governance requirements including Financial regulatory authority (FRA) and Treating Customers Fairly
Desired Candidate Profile
What We re Looking For
- Graduate level with a medical background is essential
- Good spoken and written Arabic and English is essential
- Multilingual skills would be an advantage
- Good problem solving and prioritisation skills, with close attention to detail
- Computer and numerical skills are essential to be able to interpret data and perform calculations to ensure the accuracy
- of the claims information
- Good communicator and the ability to work well alone and as part of a team
- Good understanding of treating customers fairly and delivering compliant services within a regulatory environment is key.
Company Industry
- Medical
- Healthcare
- Diagnostics
- Medical Devices
Department / Functional Area
- Insurance
- Underwriting
- Surveying
- Actuary
Keywords
- Claims Payment Integrity Consultant
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Bupa Arabia
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 is a Level 2 Disability Confident Employer. This means we aim to offer an interview/assessment to every disabled applicant who meets the minimum criteria for the role. We ll make sure you are treated fairly and offer reasonable adjustments as part of our recruitment process to anyone that needs them.