• 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.

• Inputting 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.• Respond to all relevant incoming correspondence and queries from our internal departments.• Ensure the correct interpretation of BUPA Internationals’ policy and rules, using the correct compatible combinations of codes for accurate processing of data, in accordance with our service standards and customer expectations.• Provide excellent customer service for members as stated in Bupa aims and mission statement.• Contribute to the continuous development of the claims process by identifying opportunities for product development and process improvement.• Suspend claims that require further investigation to resolve appropriately to ensure the correct continuation of processing within agreed timeframes and standards in suspend process.• Translate Arabic documents to English when requested by other Bupa International departments.• Recognise and challenge possible fraudulent information and proactively seek to clarify and resolve using best method of communication and initiative.

• Assesses approval of medical approvals as well as policy use. • Checking a particular treatment plan is necessary for the patient. • Inputs verbal and written claims approvals regularly. • Decides approvals as per policy conditions. • Assess high-cost claims and provide decisions on complicated cases.• Provides clear feedback on queries from the Call Centre team. • Provides clients an understanding of any declined medical claims. • Coordinates workflow & meet deadlines.• Evaluates claims regarding eligibility

• Dispensing medications with appropriate patient education.• Patient counseling and ensuring compliance with laws and regulations.• Inventory management and shift leader of a team of two interns.• Ensure patient’s satisfaction with professional customer care approaches.