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Key Accountabilities
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Key Activities / Decision Areas
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1
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Medial cost & Service Management
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Adjudicate the cases (In-Patient & Out-Patient) based on common medical prcatice and inline with Bupa protocols and policy .
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Ensure the decisions are according to the best medical standards and agreement terms & conditions in order to prevent abuse, fraud and overtreatment.
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2
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High quality medical decision & patient safety
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Ensure working with high quality of decision making with Zero QDI (Quality Demerit Index) A or B
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Ensure the medical decisions are consistent and are implemented based on clinical and practice guidelines signed off by the organization.
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Ensure high customer satisfaction in line with BUPA values and business strategy.
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3
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Efficiency management
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Ensure achieving the daily targets in terms of productivity & speed of response.
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Ensure proper interpretation and usage of clinical skills.
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4
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Compliance to policy and Regulation
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Report all high value calims as per agreed process.
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Highlight and report fraud, abuse, and anti-selection.
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Apply terms and conditions of BUPA declaration policy in SME products.
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Follow CCHI policy’s terms and conditions.
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5
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Support & contribute in capability building
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Constantly upgrade his knowledge and experience in order to meet challenges.
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Offer professional help to the rest of his team members.
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Provide positive feedback and help in solving problems.
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