Reporting to the Medical Contracts & Compliance Manager, this role will support the management of the Bupa Medical Networks and broader Medical Propositions and will be responsible for the maintenance and support of Medical providers contracted to Bupa for the delivery of both Inpatient and Outpatient Medical Services. These contracted network providers are needed to ensure delivery of the best possible health outcomes for both our Domestic and International health insurance customers at a sustainable cost to the business whilst ensuring price transparency for customers. The role will also assist in delivering enhancements to the network operation and ensure system readiness so that providers and customers enjoy a seamless and positive claims experience, whilst working to reduce out of pocket expenses for customers. How will I help? Key accountabilities include:
Assist in the management of medical network providers by proactively contacting and assisting Providers via phone and email with regards to their use of the Bupa Medical Networks (Medical Gap Scheme, BupaFriendly, MPPA's).Assist Providers with registration, claims submission and payment enquiries, whilst ensuring network providers are delivering contractual obligations through reporting.Support the expansion of electronic claiming and eligibility usage, and updates to Bupa core systems.Assist in the management of Provider Web search and online content and provide support to initiatives which raise awareness and utilisation of the Medical Networks.Review internal collateral and/or business requirements documents to support the delivery of an enhanced CVP and/or business objectives.Undertake Provider claiming and compliance review through appropriate analytics and reporting and identify, communicate & make recommendations on areas of potential business risk.Review customer verbatim and complaints and identify areas of opportunity.What do I need? A thorough understanding of Bupa Medical Networks, agreements, claims & benefit systems.Experience dealing with both International and Domestic claims desired.Experience dealing with electronic claims channels highly desired.Experience dealing with providers is desired.High levels of computer literacy, including excel, access, word, power point.Strong numeracy skills with an ability to create reports as required.Highly developed written and verbal communication skills.Demonstrated understanding of financial reporting.Legislative understanding of the National Health Act, Privacy Act (Commonwealth), and other related acts.What is it like to work there? Bupa is an international healthcare group which has been committed to a purpose of helping people live longer, healthier, happier lives and making a better world for more than 70 years. Bupa Asia Pacific operates in Australia, New Zealand, and Hong Kong, supporting about 6.5 million customers through a broad range of health and care services including health insurance, aged care, dental, medical, optical, and hearing services. Employing more than 20,000 people in the region, we believe that we can make a real difference to the lives of customers through our values, purpose, and the way that we deliver personalised care.
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