Operations Support (MCU) (TPA)

Job Description

Enhancing of CX of clients concerned with non-approved cases and Referral management cases through applying of PA decision review, case management process, direct contact with clients, and coordination with both internal and external stakeholders within a defined time frame and restrictions of TOB. More-over, pinpoint and tackle the root causes that result in the non-approval to enhance the volume and quality of the non-approval decisions.

Manage MCU Recovery\ Referral work list cases

• Review cases appearin on Aramco MCU list either diverted from PA work list or created by other stake holders to ensure the quality of the decision as well as the application of TOB guidance by PA users / automated system.
• Review referral cases to proceed with allocting the requested services and issuning the needed referral document when requested.
• Good judgment, adaptive business intuition, and strong teamwork skills to work well with team members

Communications with internal and external stakeholders

• Direct interaction with clients through phone calling for explanation of decision, process and obtain necessary data (for outpatient cases only), to be highlighted to mangers\Sr. managers in the recovery team.
• Respond to the internal stakeholders' queries via CMT\Emails.
• To perform oubound calls for members experience assessment.
• To communicate with patients in NPR cases when needed.
• Capability to work within the frame of legal and operational requirements which defines the guidelines of interaction with clients either imposed by Bupa, regulators or the client institution.

Actively share in analysis, and problem solving

• Coordinate with data analysts and use simple problem solving and root cause analysis tools to monitor any deviation in the breakdown, volume and origin of cases managed on the recovery list.
• Recording of the done transactions in platforms\excel sheets on daily basis

Skills

• Strong logical, analytic, Presentation, assessment and interpretation skills
• Advanced communication and negotiation skills.
• Basic to intermediate knowledge of Microsoft Office
• Able to multitask and work well under stress.
• Strong troubleshooting, problem-solving and analytical skills, excellent follow up skills.
• Ability to effectively prioritize and execute tasks in a high-pressure
• A medical science degree (pharmacology, clinical laboratories, Nursing., physiotherapy…etc.)
• Any degree/ training in Excel, Data Management and Dashboards, Business Writing, Client Management shall be considered