Claims integration (Pipeline)
Bupa Arabia
Date: 1 day ago
City: Jeddah
Contract type: Full time
Job Description
Processing provider claims and applies regulator KPI in addition to execute key projects that supports the claims efficiency and other key business priorities.
Claims efficiency & Provider process:
- Received and validate providers submission through NPHIES within KPI.
- Received and validate providers documents such as invoices, approvals, and all related support documents.
- Give orientation to providers for claims guide.
- Communication with the providers and follow up in any requests, rejection and inquiries
- Ensure adherence to legal and company policies and procedures
Reporting:
- Collect and analyse data received from providers.
- Create and maintain report and dashboards to track key performance.
- Develop and implement data quality checks to ensure accuracy and consistency of data
Project Support:
- Support in planning projects and provide materials and tools to help excute NPHIES projects
- Ensure post-implementation benefits realization are reported accurately and on timely manner
Hotline & Resolve PR Complaints:
- Handle calls from providers, provide solutions related to claims submission and check the dashboard to evaluate the total calls
- Resolve PR escalated cases in timely manner
Skills
- Bachelor’s degree Business Administration or relative majors.
- Experience in health insurance field
- Proficiency in English and Arabic (spoken and written)
- Microsoft Office skills
- Communication skills
- Interpersonal skills
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