High Risk Claims Consultant - Bupa Global

High Risk Claims Consultant - Bupa Global (Fixed Term)

Bupa Victory House, Trafalgar Place, Trafalgar Street, Brighton, UK, BN1 4FY

Full time - 35 hours per week

Fixed Term (Contract ending April 1st 2027)

From £25,500 per annum dependent upon experience and qualifications

Hybrid Working (Minimum office working 1 day per week)

We make health happen 

Bupa Global is the international health insurance division of Bupa. We provide customers who want premium international coverage with products and services to access the healthcare they need anytime, around the world, whether at home or when studying, living, travelling or working abroad.

Bupa Global has offices around the world including London and Brighton (UK), Dublin (Europe), Miami (USA), Dubai (UAE, in partnership with OIC), Egypt and Hong Kong (China) as well as regional offices in mainland China, Singapore, the Dominican Republic, Bolivia, Panama, Guatemala and Ecuador.

This is a diverse and skilled customer facing role where you will be responsible
for balancing cost containment opportunities with fair and accurate customer
outcomes, and at all times resolving any claims queries to the customer’s /
providers complete satisfaction without the need to refer the customer / provider on.

Your individual performance will be a key contribution to the department
achieving all targets for quality, productivity, cost containment, compliance and
regulation. You will be a claims subject matter expert, putting the customer / provider at the centre of everything you do and using your claims knowledge to put forward ideas for the continual improvement. You will identify and act upon issues that affect the customer experience and any cost or risk exposure. Authority as per Bupa Global Delegated authorities framework. You will consult with other team members, Service Managers, Health Care Management colleagues and the Continuous Improvement Partners. Roles are on a shift rotation basis which can include weekends and public holidays depending on business requirement.  

How you’ll help us make health happen:

• Taking end to end ownership for the resolution of all customer / provider claims enquiries. Case manage all queries through to resolution

• Extensively and accurately adjudicating high value claims that are
  referred across, or are submitted directly; ensuring savings opportunities
  are maximised where appropriate

• Actively working the High Risk Claims referrals in Swan, identifying
  savings, potential fraudulent member/provider behaviour.

• Actively work SHIFT referrals to ensure savings are maximised

• Actively participate in meetings with stakeholders around the business

• Ensure all savings records are accurately recorded upon their relevant
  spreadsheet

• Accurately maintaining and updating customer records on the customer
  management system. Ensure that records are accurately updated whenever a customer makes contact

• Complying with all regulatory and governance requirements including FCA and Treating Customers Fairly ​

Benefits 

Our benefits are designed to make health happen for our people. Viva is our global wellbeing programme and includes all aspects of our health – from mental and physical, to financial, social and environmental wellbeing. We support flexible working and have a range of family friendly benefits. 

Joining Bupa in this role you will receive the following benefits and more: 

• 25 days holiday per year, pro rata to your contract.

• Access to a range of services to support your physical and mental wellbeing

• Fixed term benefits allowance

• Access to our confidential employee assistance programme

• Workplace pension

• Online discounts covering your everyday shopping, entertainment, eating out and more. 

Why Bupa? 

We’re a health insurer and provider. With no shareholders, our customers are our focus. Our people are all driven by the same purpose – helping people live longer, healthier, happier lives and making a better world. We make health happen by being brave, caring and responsible in everything we do. 

We encourage all of our people to “Be you at Bupa”, we champion diversity, and we understand the importance of our people representing the communities and customers we serve.  That’s why we especially encourage applications from people with diverse backgrounds and experiences.  

Bupa takes pride in being a Level 2 Disability Confident Employer and will aim to offer an interview/assessment to disabled applicants who best meet the minimum criteria for the role. We’re committed to ensuring you’re treated fairly during the recruitment process and offer reasonable adjustments to anyone who may benefit from accommodations to the recruitment process.   

If you require information regarding this role in an alternative format, please email: [email protected]