Clinical Assessor

2 weeks ago

Greater Adelaide SA, Australia Bupa Full time

As the Clinical Assessor - you are primarily engaged in assuring that benefits are paid towards members’ claims when appropriate, identifying when claims are not eligible under legislation or Bupa rules, and assuring that members or providers are advised in a timely and empathetic manner.

Assessors are involved in the delivery of timely customer solutions and deliberations in accordance with Bupa's fund rules, Private Health Insurance legislation, product coverage and Bupa’s policies, procedures and service standards. Communicating decisions on eligibility to customers and health service providers on a case-by-case basis.

**How will I help?**

Key accountabilities include:

- Deliver accurate, timely and efficient clinical assessment of all claims managed by the team.
- Maximise savings for all Acute Care Assessments by utilising ICD code review and recognising Hospital “out of cycle” submissions.
- Identify and recommend opportunities for process and functional improvements that support this review.
- Act within “Eligibility Line” roster requirements, completing phone calls and answering queries from providers and other areas of the business requiring clinical assessment.

**What’s in it for me?**

As well as a competitive salary, a range of Bupa benefits and flexible working/ work from home arrangements, you’ll be challenged and encouraged to innovate. You will collaborate strongly with colleagues who are committed to delivering exceptional experiences. We trust, respect and consider everyone, knowing your difference will make the difference.

**What do I need?**
- High level written and verbal communication skills with proficiency in having professional conversations with customers and providers.
- Customer Management Systems familiarity essential. (Cyclops, BOSS, IWS Workflow, Bupa Products or comparable systems)
- Medical Terminology Accreditation preferred (if you do not currently have Medical Terminology Accreditation you will be provided the opportunity to complete)
- Keyboard and Data Entry Skills of a high level and accuracy Microsoft Office Package desirable but not essential

**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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