Join our team of Assessors and learn to be a subject matter expert in compliance and eligibility assessment in the health insurance industry. You will help assure appropriate benefits are paid towards our members’ claims. and identify when claims are not eligible under legislation or Bupa’s fund rules. Your role is that of investigator and expert in the detection of when claims are or are not eligible for benefits to be paid. You will be supported by a team of similar investigators as well as experienced managers and a team of medical practitioners. How will I help?
People covered by private health insurance expect their claims to be paid efficiently and promptly. They also expect that their contributions don’t go towards people who aren’t covered and haven’t been paying contributions towards private health insurance as they have. Some people choose health insurance products with certain restrictions on what might be covered. It’s not always straightforward.You will investigate and help determine whether relevant claims are eligible to receive benefits under the provisions of the level of cover held by the member. To do so you will use the knowledge of health insurance products you will gain in our team, your inquisitive mind and your powers of deduction. Senior people in the team and doctors working with us can help you come to decisions and make recommendations fairly and with proper regard to our members’ rights and expectations. Key accountabilities include:
1. Deliver accurate, timely and efficient clinical assessment of all assigned claims.
2. Communicate with our customers with consideration, empathy, and proper respect for people who are experiencing health and financial pressures. The same professional approach is to be applied to communication with health care practitioners, providers and other relevant stakeholders.
3. Identify and recommend opportunities for process and functional improvements that support this review.
What’s in it for me? As well as a competitive salary, a range of Bupabenefits and flexible working/ work from home arrangements, you’ll bechallenged and encouraged to innovate. You will collaborate strongly withcolleagues who are committed to delivering exceptional experiences. We trust,respect and consider everyone, knowing your difference will make thedifference.
Other benefits includediscounts on our health insurance, travel, car, home, contents and petinsurance products as well as Bupa services such as Dental and Optical. You canalso access a ‘People First’ wellness program which provides a range ofservices such as health coaches, annual skin checks and flu vaccinations,assistance with nutrition, mental and general well-being guides and productdiscounts.
What do I need?
This position may suit someone with experience or an interest in investigating and reviewing claims within a framework of policies and legislation.
4. Solution-focused to identify a fair assessment for our customers claims in accordance with policy rules
5. Learns and retains new skills and information easily
6. Self-starter, enjoy learning new systems, processes and comfortable in navigating legislation to ensure compliance
7. Very good written and verbal communication skills to engage in professional conversations with customers and providers
8. Familiarity with Customer Relationship Management systems is an advantage but not essential
9. Competent in using MS Office suite with advanced data entry skills
10. Previous experience working in insurance or healthcare industries would be advantageous but not essential
What is it like to work there?
Bupa is an internationalhealthcare group which has been committed to a purpose of helping people livelonger, healthier, happier lives and making a better world for more than 70years.
Bupa Asia Pacific operatesin Australia, New Zealand, and Hong Kong, supporting about 6.5 millioncustomers through a broad range of health and care services including healthinsurance, aged care, dental, medical, optical, and hearing services.
Employing more than 20,000people in the region, we believe that we can make a real difference to thelives of customers through our values, purpose, and the way that we deliverpersonalised care.