Global Case Manager

Bupa
Hong Kong
Workplace: OnsiteFull timeFunction: Solutions Engineering & Sales EngineeringEducation: bachelorsSkills: ["Communication","Organizational","Analytical","Interdisciplinary collaboration"]

Support complex medical case management for high-value claims and clinical pre-authorization by gathering relevant clinical information, applying coding systems accurately, and ensuring correct interpretation of Bupa Global policies. Investigate and respond to enquiries with internal and external stakeholders, proactively identify fraud or abuse, and evaluate care outcomes with the interdisciplinary team. Triage complex cases and coordinate evacuation/repatriation case allocation in line with SLAs while pursuing opportunities to reduce future claim expense.

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FursaFursa
Bupa
Bupa
11 hours ago

Global Case Manager

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Source: Company careers pageValidated by: Fursa AI
Last checked: 11 hours agoStatus: Live
Reposted: similar role first listed 6 months ago

Job Summary

Support complex medical case management for high-value claims and clinical pre-authorization by gathering relevant clinical information, applying coding systems accurately, and ensuring correct interpretation of Bupa Global policies. Investigate and respond to enquiries with internal and external stakeholders, proactively identify fraud or abuse, and evaluate care outcomes with the interdisciplinary team. Triage complex cases and coordinate evacuation/repatriation case allocation in line with SLAs while pursuing opportunities to reduce future claim expense.
Location: Hong Kong
Workplace: Onsite
Employment Type: Full time
Job Function: Solutions Engineering & Sales Engineering

Key Responsibilities

  • •Identify and gather relevant clinical information to update the patient management system and selected clinical software tools.
  • •Investigate and respond to complex medical pre-authorization and high-value claims across internal and external stakeholders.
  • •Ensure accurate interpretation of Bupa Global policies and rules using the appropriate coding system.
  • •Proactively identify fraud and/or abuse and report to the appropriate parties.
  • •Triage complex case management needs, including evacuation/repatriation support, and monitor case progress in line with agreed SLAs.

Key Requirements

  • •Bachelor’s degree or above in healthcare or a related discipline.
  • •Doctor or RN experience with speciality (local or overseas) is preferred.
  • •Knowledge of a coding system is required.
  • •Experience making decisions in a clinical setting with a wide range of clinical conditions.
  • •Working knowledge of healthcare systems and resources, plus excellent communication and organisational skills.
Experience:HealthcareInsurance
Education:Bachelor's
Skills:CommunicationOrganizationalAnalyticalInterdisciplinary collaboration
Tech Stack:Microsoft WordMicrosoft Excel

Company Brief

Bupa
Bupa is an international healthcare group offering health insurance, care homes, hospitals, dental clinics, and health services. It provides private medical insurance and integrated care solutions across multiple countries for individuals and employers.
Industry: Health Insurance (Payers)
Company Size: Enterprise (1,001+ employees)
Revenue: USD 1B+
Growth: Established Company
Headquarters: London, United Kingdom
Founded: 1947
WebsiteLinkedIn