Healthcare services Process (TPA) - Pipeline

Job Description

To oversee medical care unit for TPA account, To ensure that all medical care unit sub units are delivering the PG and the decisions taken by the team is as per defined policy guidelines that are compatible with high medical standards that help in safe-guarding member’s health & safety & also being compliant with IA , clients Regulations & BUPA values . managing the rejection recovery, Referral management and occupational checkup

Service Management

• To Grant that team is delivering the agreed PG's with client

• Ensure the decisions taken by the team are according to the best medical standards and agreement’s terms & conditions in order to prevent abuse, fraud and overtreatment.

Quality medical decision & Patient safety

• Ensure working with High Quality of decision making with Zero QDI (Quality Demerit Index) A or B

• Ensure the medical decisions are consistent and are implemented based on clinical and practice guidelines signed off by the organization.

• Ensure high customer satisfaction in line with BUPA values and business strategy

• Ensure compliance to regulator and client during service delivery.

Operation excellence

• Process improvement initiatives to achieve excellence

• Lead the team and deliver service strategy agenda

Capability Building & People Management

• Ensure and facilitate goal setting; manage and constantly review individual performance

• Provide regular feedback, coaching and development

• Motivate, empower and enable direct reports by providing the necessary tools and support

Support the business & communicate effectivily

• Discuss & report the requested reports by the clients with invloved parties

• Take active part in complaint management and communicate effectively (inter/intra department)

• Participate effectively in weekly monthly meetings

• Manage any crises effectively based on already set business continuity plan

Skills

• 3 years in medical insurance/administrative field

• 2 years in medical /clinical field practice

• Language (English) and computer skills

• Cababple of producing efficient reports and presentation

• Clinical experience as General Practitioner / Emergency / Family Medicine

• Medical insurance practice

• Bachelor’s in Medicine

• Postgraduate in Medicine / Masters in Business Studies, preferable .

• 5 years experience at least in medical field ( Hospital practicing ) or at insurance field

• Leadership and Analytical skills

• Crisis Management