Medical Representative
Gulf
Total years of experience :8 years, 4 Months
to promote and sell company medications to doctors, pharmacists, and other relevant healthcare professionals. The medical representative’s responsibilities include persuading potential customers to purchase company medications, identifying prospective business opportunities for the company, and providing the relevant departments with customer feedback.
Approving/rejecting all requests to authorize treatment before any surgery or procedure. • Deal with members’ telephone enquiries, evaluate the situation and apply business criteria and detailed knowledge of Bupa Global products to make appropriate decisions. • Respond to members’ correspondence either by phone or by writing following appropriate investigation, in line with Bupa Global policy and style. • Respond to members’ visits by evaluating their situation and requests and accordingly provide them with the necessary advice/ action. • Apply changes to existing memberships according to Bupa policies and processes • Reissuing and tracking members’ documents • Making manual collections from customers’ credit cards • Deal with billing inquiries. • Raising manual credit notes and invoices when needed • Issuing membership letters for customers to confirm cover • Issuing payment receipts for members and group payments when requested. • Deal with providers that may have any queries related to their dealings with Bupa Global or on behalf of their clients. • Take responsibility for ensuring that the system records reflect up to date communications with internal and external customers so that enquiries can be dealt with quickly and efficiently. • Ensuring members’ contact details are up to date on the system. • Provide support to other Bupa Global Departments to overcome cultural and language barriers. • Coordinate with Service Partners to set medical treatment appointments for members seeking treatment internationally. • Handling members complaints and accordingly investigate situation and coordinate with other departments in order to solve the complaint in a timely manner and retain the customers. • Use agreed levels of authority and previous experience to make effective business decisions. • Take ownership of the enquiries and liaise between departments to provide a ‘seamless service’ to members. • Support new team members throughout their learning curves. • Ensure that the team objectives are met throughout the year.
* Evaluate and process Outpatient, Pharmacy and or Inpatient prior authorization requests in accordance with respective policies schedule of benefits.
* Evaluate the medical need for the requested service according to the medical data provided and accurately code the service description codes stated on the prior authorization requests, according to accepted medical coding rules, medical guidelines and policy’s schedule of benefits.
* Provide accurate and complete documentation with rationale used to approve request.
* Achieve the proper capturing of the data on the system with a focus on accuracy, efficiency, ensuring that business decisions and processes are documented in a professional way.
* Ensure that the medical ethics are respected at all times during the fulfilling of the tasks.
* Report suspected cases of fraud and/or abuse of the healthcare providers to respective medical authorization supervisor.
* Handle changes in the workload flow from healthcare providers in terms of time, quantity and type of prior authorization requests received with a clear focus on both quality and set target.
* Responsible for receiving, evaluating, and escalating second opinion cases and case management.
* Perform night shift duty to sustain any issues and queries related to Authorization department.
* Approve outpatient and or inpatient claims in line with medical policy terms and ensure approvals are issued within set turnaround time.
* Authorize pharmacy requests when needed by the team, in line with medical policy terms and ensure approvals are issued within set turnaround time.
* Maintain data / reports pertaining to individual performance.
* Review medical trends, identify fraudulent cases and bring them to the notice of Team Leader to minimize abuse of medical insurance.
promote and sell company medications to doctors, pharmacists, and other relevant healthcare professionals. The medical representative’s responsibilities include persuading potential customers to purchase company medications, identifying prospective business opportunities for the company, and providing the relevant departments with customer feedback. You should also be able to attend company meetings and training sessions.
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Master of business administration