Manager - Onsite Claims Management

Onsite Claims Management Manager

The Onsite Claims Management Manager is responsible for ensuring that assigned provider’s Inpatient claims are accurately and efficiently adjudicated onsite at the hospital within the specified timeframe and quality standards. This role is crucial for Bupa to deliver high-quality claim IP statements and maintain a smooth business operation.

• Adjudication: Review and process all IP cases/claims onsite at the hospital, adhering to medical policy, line items, invoices, and Inpatient adjudication guidelines. Utilize your medical background and instructed guidelines to make decisions that prevent abuse, fraud, and overtreatment.
• Quality Assurance: Achieve a minimum of 95% accuracy level in daily quality audits to maintain the required quality standard. Make sound medical decisions that minimize challenges from providers and consult with the medical manager when in doubt.
• Fraud and Abuse Identification: Identify and report abnormal trends in provider practices and escalate FWA cases to the concerned teams. Monitor identified providers' trends on a monthly basis.
• Support and Capability Building: Continuously upgrade your knowledge and experience to meet challenges. Offer professional help to your team members, provide positive feedback, and assist in problem-solving.
• Workplace and Roving Function: Adjudicate claims onsite at assigned hospitals daily, based on case volume and flow. Be present at the hospital as needed and rove between assigned hospitals.

Skills and Qualifications: Clinical experience, medical insurance experience, and an MBBS degree (Bachelor of Medicine & Surgery) are essential for this role.