وظائف مكة المكرمة

Job Purpose: To deliver the healthcare partnership operations functions and supporting healthcare partner projects in order to drive the healthcare partner pillar of Bupa Arabia. # Key Accountabilities Key Activities / Decision Areas 1 Healthcare Operations Service Recovery · Liaise with medical and non-medical staff at providers to ensure quality healthcare service for our members · Conduct Outbound calls to Pre-Authorization Rejected members based on specifically defined and approved criteria · Receive Inbound calls from Pre-Authorization Rejected members based on specifically defined and approved criteria · Review and recover the rejected members by explaining the rejection reason to them in a professional manner · Rework any case that is medically justified, in alignment with the Pre-Authorization, to build trust with our members · Maintain and update a daily database and tracker of all issues raised and members touched · Conduct follow up on open cases to ensure optimal members recovery and issue resolution · Answer medical queries from CS, HAD, Delegates, etc. 2 Healthcare Operations Operational Excellence · Engage Inpatient members by conducting Outbound calls based on specific and clearly defined criteria · Maintain and update a database for the treating doctor and provider/hospital service delivery review of the customer experience based on clearly defined matrix and service levels · Conduct follow up on open cases to ensure optimal members recovery and issue resolution 3 Healthcare Projects · Support the delivery of healthcare projects by conducting follow up calls and coaching of our members for all healthcare projects and initiatives launched 4 Healthcare Operations Service Excellence · Conduct Doctor Chats through the Bupa Arabia website and answer member queries · Receive Member Helpline Inbound calls from both Bupa Members and Non-Members · Collaborate with the Sales team and send potential leads to them · Conduct Outreach programs with Groups/Customers to promote healthcare partnership and wellness agenda · Participate in Healthcare campaigns, such as Breast Cancer, Chronic Disease Management Programs etc. Role Dimensions Financial (limits/mandates etc.) Non-financial (customers/staff etc) · Members · Treating Doctors · Non-Medical personnel · Inte
al Stakeholders (such as Pre-Authorization (PA), Provider Relations(PR), Hospital Audit Doctors(HAD), Customer Service) Application Criteria: Main Contacts (exte
al and inte
al) Contact group · Members · Treating Doctors · Delegates · HAD · Pre-Auth · PR · Fraud Unit · Healthcare Projects Team · Exte
al Stakeholders Frequency · Daily · Daily · Daily · Daily · Daily · Daily/As Needed · Daily/As Needed · Daily/As Needed Purpose · Complete member recovery · Complete issue resolution · Closing the gaps in case of deviations · Long term prevention · Deliver high quality healthcare · Meet and exceed member expectations · Build strong relationships with members and providers · Enabling and educating members to make informed decisions about their health المهارات المطلوبة Person Specification Education · Qualified, certified Medical doctor Experience Fields · Pre-Authorization/Insuran ce experience · Quality Management · Service Delivery Skills Years of Experience · Minimum 3 years