Care-coordinator - BEI
Core
Evaluate and authorize complex medical preauthorizations and high-value claims for international health insurance members.
Role type
Senior IC care coordinator (medical insurance)
Builds
Medical authorization decisions and claim resolutions for Bupa Global members
Domain
Health insurance / Medical claims adjudication
Required skills
Medical insurance experience, clinical background (pharmacist/physiotherapy), medical decision-making, clinical billing and coding knowledge, analytical skills, telephone communication
Preferred skills
Knowledge of clinical billing and coding
Responsibilities
Investigate and respond to complex medical authorization and high-value claims; Pro-actively contact members and providers to explain benefit entitlements; Liaise with global clinical staff to interpret conditions and treatments against policy; Work with audit teams to investigate fraud or abuse; Negotiate medical costs and treatments to reduce business expense or optimize member care; Prepare case reports and daily activity records; Identify opportunities to reduce future claim expenses.
Seniority
Mid-level, hands-on IC