Job closed
Ref: GP797-40
Job description / Role
Job Purpose:
To ensure that provider claims will be adjudicated within the specified timeframe and with the targeted quality to achieve the business objective of delivering good quality statements within the assigned KPI
Roles & Responsibilities:
• Process all the daily batches of claims assigned using medical background in conjunction with the medical policy and instructed guideline, day-in-day-out for smooth operation of business activity
• To achieve required quality though achieving 98% accuracy level of the monthly quality audits, in order to maintain the quality standard set for the job
• Assure that each claim has been processed as per the checklist of steps involving checking of physical system, and data on the system, in order to get the right decisions on the claims
• Make sound medical decision that minimise the opportunity to be challenged by providers
• As required, any other allocated activity with tin the business
Dimensions:
Supervising the quality of services and output of the medical staff team, including doctors and nurses. Normally will be responsible for managing the activities of medical practitioners. Can over side medical decisions of staff subordinates, and normally is involved with high value cases exceeding SR 50,000.
Requirements
Qualifications & Skills:
• University degree (BS) in Medicine ; and 2 - 3 years of experience in the similar field
• Post-graduate diploma in the medical field
• 2 - 3 years of experience in the medical field
• Ability to communicate clearly read and write effectively; in English and Arabic
Competencies:
1. Team work
2. Organizational Awareness
3. Workforce Management
4. Customer Focus
5. Results Orientated
About the Company
BUPA Arabia is the health insurance company public shareholding cooperative paid up capital of 400 million riyals, and the only medical insurance company specializing in this area , part of the BUPA International healthcare.
We have a local experience of more than 10 years of global experience of the Bupa Group more than 60 years of BUPA Arabia to make the first option and the best in the field of medical insurance.