Loading...
Job Details of Medical Operations Support (Mega AC)
Medical Operations Support (Mega AC)
Jeddah Full-timeJob description
- Ensure great delivery of service and support to members within agreed KPIs and to meet Referral unit targets
- Ensure to improve the customer expirance by delivering high CSAT.
- Ensure to apply Referral cases policies and procedures, according to department KPIs.
- Manage escalated cases from the agents.
- Ensure to apply Referral cases policies and procedures, according to department KPIs.
- Align with business service strategy , e.g. up your service ... etc. to deliver customer satisfaction.
- Full implentation of different bupa products, values and policies, to reflict bupa images in front of the customer.
- Highlight any recurring problems and accordingly take corrective actions to resolve the case.
- Identifying the root cause of issues to check any process failures.
- Foster and maintain collaborative relationships with cross-functional departments.
- Liaise with PA team for rejections discussions (through CMT tool)• Liaise with BCC team in different hospitals.
- Work hand in hand with the customer care representative • Serve as a medical consultant for Bupa customers to assess their policy performance and provide guidance throughout the underwriting year.
- Utilize medical expertise to recommend the most efficient healthcare providers in terms of cost and effectiveness.
- Ensure recommendations align with client approval and adhere to agreed protocols between the Bupa and the client.
- Achieve high satisfaction rate Bupa client regarding tailored medical recommendations and cost-efficiency.
- Act as a healthcare navigator to assist insured members in understanding their medical needs and available service provider & treatment options.
- Guide members through complex healthcare systems to access appropriate care within insurance coverage.
- Coordinate with the appointed gategeeper to ensure seamless healthcare experiences for the members
- maintain continuity of care for eligible patients.
- Ensure 95% of the members report a positive experience in navigating their healthcare journey in line with the referral matrix.
- Ensure proper, accurate records, files, and databases are set up and maintained.
- Ensure fully explain with maintain a high level of NPS survey.
- Build a strong relationship with the pre-authorization team, providers relations, and providers to deliver the services.
- Update tracking of Referral cases, and resolution, and send regular reports or summary.
- Analyse case trends and behavior to collect key information to aid in identifying possible complaints.
- Maintain a communication response time of less than 24 hours and achieve 100% compliance with established protocols and regulations.
Skills
- Healthcare industry experience, with a strong understanding of healthcare terminology and analytics
- Excellent presentation, communication, and interpersonal skills to effectively interact with colleagues and stakeholders
- Proficiency in Microsoft Office, specifically Excel, PowerPoint, and Word
- Strong analytical, problem-solving, and troubleshooting skills, with the ability to think critically and strategically
- Proven ability to prioritize tasks effectively in a fast-paced environment, with excellent follow-up skills
- Strong analytical and logical thinking skills, with the ability to break down complex problems into manageable steps and drive solutions through iterative analysis.
How To Apply
Downloads
Download our application from Playstore & AppStore to enjoy more proffesional features.
