Tamheer -Elite Program

Bupa Arabia; Al Khobar; On-site; SAR 150,000 - 200,000; Full time

Job summary

A leading healthcare provider in Al Khobar is seeking a dedicated professional to manage member experiences and facilitate core healthcare services. The role includes ensuring timely service delivery and acting as the main contact for members' inquiries. Ideal candidates possess strong operational skills in handling claims and approvals, with excellent communication abilities. A flexible approach and a healthcare background are preferred, making this a unique opportunity to contribute to quality member care.

Qualifications

• Strong operational handling of reimbursement claims and pre-authorization.
• Experience in providing service to members.
• Ability to communicate effectively and clearly.

Responsibilities

• Manage members' experience with healthcare services.
• Proactively facilitate healthcare services to members.
• Serve as main contact for member inquiries about services.

Skills

Handling cases on Reimbursement claims

Knowledge in HCO/Tebtom services

Customer-focused service orientation

Excellent communication skills

Flexible to receive/make calls outside working hours

Healthcare background

Job description

Job Description

• Manage members’ experience with the relevant operational functions to ensure that services are delivered to the members end to end in every touch point of their journey on a timely manner.
• Proactively propose and facilitate Tebtom and all other core healthcare services to the members to ensure that they will receive an appropriate care customized to their current medical needs.
• Serve as the main point of contact in providing timely information to the members about Bupa services i.e. pre-authorization, reimbursement claim, Tebtom, hospital delegate services, etc.
• Collaborate with cross functional service leaders to customize healthcare services according to the healthcare needs of the targeted population.
• Constantly striving in providing excellent service by collecting post-service feedbacks through online questionnaire to assess the quality of service provided to the members.
• Provide accurate and useful information to the members and their families on medical information or specific Bupa services.
• As necessary direct the members to the recommended doctors and/or alternative providers to ensure that they will be receiving a high level of quality in medical services.
• Assess the medical need of the members and refer her to appropriate department i.e. HCS for corresponding medical coaching intervention as required.
• Support the understanding of customer and consumer segmentation to offer breakthrough Healthcare services
• Support the implementation and segmented serving of our core healthcare services
• Report & lead consistently the reporting of KPIs updates for each service offering with data analytics team of the departments
• Lead the development and maintenance of Personal Coordinated Care (PCC) dashboard to monitor, review and report progress of KPIs against targets in a consistent manner
• Prepare, manage and conduct presentations and business updates to key leaders within the organization
• Provide monthly feedback report on the progress of PCC program as part of updates in overall Retention report
• Analyse the top recurring issues or service failures which members are facing in the critical touch point along the customer experience journey, and with all stakeholders identify solid actions to eliminate or at least reduce the problems at the minimum level
• Monitor and review the progress of Kaizen projects implementation in a timely and consistent manner using a structured action plan and tracker
• Ensure risk identification, escalation and mitigation of risks in a timely manner to identify and resolve any impact on project outcome or agreed timelines during project delivery

Skills

• Fully operational in handling cases on Reimbursement claims, Pre-authorization approval, commercial approval requests, Membership and benefits coverage
• Working knowledge in HCO/Tebtom, International and POC services
• Highly customer-focused and strong service orientation providing superior services to Bupa members
• Excellent verbal and written communication skills, with the ability to convey issues in a clear, concise and effective manner
• Flexible to receive inbound calls and make outbound calls from/to the members and during weekend, holidays and outside working hours
• Preferably having healthcare background