Healthcare Management Advisor
Hong Kong

Accountabilities & Activities

  • Review medical cases and provide advices from clinical health perspective
  • Review and be accountable for the maintenance and uplift of diagnostic and medical codes for the business
  • Work with Claims and Pre-authorisation team to handle outstanding cases
  • Develop clinical protocols and claims pathways
  • Review and maintain information pertaining to medical treatments and technologies together with Bupa’s centre of clinical effectiveness
  • Support the Healthcare Payments Integrity team with invoice review and HRM processes
  • Set SOPs, develop audit programs / processes escalation hierarchy, issues / risk analysis and mitigation parameters
  • Establish and enhance procedure guideline and process workflow for operation efficiency
  • Participate in project planning, monitoring and management
  • Provide guidance and share new approaches to teammates
  • To be successful in the position, you should ideally have

  • Higher diploma / associate degree in nursing or clinical field
  • 3 years’ relevant experience in medical insurance is preferred
  • Experience in running projects is an advantage
  • Excellent communication, interpersonal and negotiation skills
  • Good analytical and problem solving skills
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