|
#
|
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.
|
