Claims Clinical Auditor

Job Description:

Claims Clinical Auditor

Cairo, Egypt

Hybrid working options

Permanent

Full time

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.

We make health happen

As a clinical auditor, your role will involve enhancing and upholding the Clinical Audit Strategy. You'll achieve this by proactively analysing data and recommending best practices, to ensure that the therapies chosen and benefits utilised during the customer journey, offer optimal value for money and are conducted efficiently, all while ensuring a positive customer experience. Additionally, you'll assist in implementing standardised medical care management guidelines throughout the organisation.

How you’ll help us make health happen:

• Support the clinical team in holistic care and update documentation
• Conduct audits and lead service improvements
• Analyse claims to manage and reduce expenditure
• Provide clinical advice to claims teams
• Collaborate on claims review and benefits policy
• Provide monthly data analysis to stakeholders
• Implement standardized care management guidelines
• Audit healthcare providers' records and billing
• Investigate health insurance misuse
• Document decisions and processes confidentially
• Prepare audit reports and follow up on recovery
• Understand claims cycle and provider behaviour
• Stay informed on legal auditing requirements
• Identify improper billing practices
• Support data quality and service encoding
• Uphold department goals and values
• Collaborate on provider audit processes

Key Skills / Qualifications needed for this role:

• A degree in medicine or equivalent, with 5+ years clinical and 3+ years insurance industry experience, especially in audit
• Experience in international private medical insurance or hospital administration
• Strong numerical skills and ability to produce financial reconciliations
• Understanding of private hospital industry pricing and quality dynamics
• Proven track record of achieving targets with high quality
• The ability to liaise with various teams and management levels; good team player
• Adaptable to new skills, changing practices, and environments
• Empathetic towards customers while maintaining professionalism
• Excellent communication skills
• The ability to work under pressure and independently.
• Confident with good influencing and appropriate challenging skills
• Organises work effectively and works independently

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 is a Level 2 Disability Confident Employer. This means we aim to offer an interview/assessment to every disabled applicant who meets the minimum criteria for the role. We’ll make sure you are treated fairly and offer reasonable adjustments as part of our recruitment process to anyone that needs them.

If you require information regarding this role in an alternative format, please email: careers@bupa.com

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