Provider Services Consultant
Current• Respond to all relevant incoming correspondence and queries from internal departments relevant to providers claims.• Re-assess and rectify provider paid claims into the computer system with a high degree of accuracy.• Action any claim related query in line with Bupa Global policy and style.• Obtain all necessary information on claims for the purpose of complete processing, including liaison with internal departments.• Ensure the correct interpretation of Bupa Global policy and rules, using the correct compatible combinations of codes for accurate processing of data, in accordance with our service standards and customer expectations.• Contribute to the continuous development of the claims process by identifying opportunities for product development and process improvement.• Suspend claims that require further investigation in order to resolve appropriately to ensure the correct continuation of processing within agreed timeframes and standards in suspend process.• Comply with and abide by the requirements of the FCA, Egyptian Financial Supervisory Authority or any other relevant regulator at all times.• Use agreed levels of authority and previous experience to make effective business decisions.• Take ownership of the enquiries and liaise between departments to provide a ‘seamless service’.• Support new team members throughout their learning curves.• Liaise closely with the Healthcare Management Team who own/manage the contracts with providers to ensure relevant provider behaviour concerns or general feedback is given to help improve overall provider relationships between all parties.
