Merna Ibrahim

- Take end to end ownership for the resolution of all customer claims enquiries. Case manage all queries through to resolution.

- Responsible for complex case handling i.e. large claim authorization, extraordinary benefits and ex-gratia payments.

- Accurately maintain and update customer records on the customer management system. Ensure that records are accurately updated.

- Participate in projects demanding decision making and high level of responsibility within operations and/or cross-departmental.

- Comply with all regulatory and governance requirements including Central Bank of Ireland and Treating Customers Fairly.

- Act as a role model for the team demonstrating outstanding personal behaviors and performance.
Work positively together with other teams and departments, treating them as internal customers and not creating barriers between departments.

- Being a Customer Service Champion within Claims. Contribute to the continuous improvement process by challenging exiting process and contributing ideas for improvement.

In addition to the claims management consultant activities, this role will involve enrolment support activity for customers based in the EEA

- Inputting claims into the computer system with a high degree of accuracy.

- To action any claim related query in line with Bupa Global policy and style.

- To obtain all necessary information on claims for the purpose of complete processing, including liaison with internal departments, using the following methods: telephone or e-mail. This may also include gaining information to research further details required to assess a claim.

- Respond to all relevant incoming correspondence and queries from our internal departments. This will be as per the Claims department key performance indicators, which state turnaround time and quality standards.

- Ensure the correct interpretation of BUPA Internationals’ policy and rules, using the correct compatible combinations of codes for accurate processing of data, in accordance with our service standards and customer expectations.

- To provide excellent customer service for our members as stated in our aims and mission statement. The job holder will need to make customer focused actions based on effective decision making skills. This will also include excellent internal customer service, with continuous contribution given towards achieving individual, team and department goals and objectives.

- To contribute to the continuous development of the claims process by identifying opportunities for product development and process improvement.

- Suspend claims that require further investigation in order to resolve appropriately to ensure the correct continuation of processing within agreed timeframes and standards in suspend process.

- Logging claims on the system under correct members’ registrations, when needed.

- Recognize and challenge possible fraudulent information and proactively seek to clarify and resolve using best method of communication and initiative.

- To comply and always abide by the requirements of all regulators.

- Inputting claims into the computer system with a high degree of accuracy.

- To action any claim related query in line with Bupa Global policy and style.

- To obtain all necessary information on claims for the purpose of complete processing, including liaison with internal departments, using the following methods: telephone or e-mail. This may also include gaining information to research further details required to assess a claim.

- Respond to all relevant incoming correspondence and queries from our internal departments. This will be as per the Claims department key performance indicators, which state turnaround time and quality standards.

- Ensure the correct interpretation of BUPA Internationals’ policy and rules, using the correct compatible combinations of codes for accurate processing of data, in accordance with our service standards and customer expectations.

- To provide excellent customer service for our members as stated in our aims and mission statement. The job holder will need to make customer focused actions based on effective decision making skills. This will also include excellent internal customer service, with continuous contribution given towards achieving individual, team and department goals and objectives.

- To contribute to the continuous development of the claims process by identifying opportunities for product development and process improvement.

- Suspend claims that require further investigation in order to resolve appropriately to ensure the correct continuation of processing within agreed timeframes and standards in suspend process.

- Logging claims on the system under correct members’ registrations, when needed.

- Recognize and challenge possible fraudulent information and proactively seek to clarify and resolve using best method of communication and initiative.

- To comply and always abide by the requirements of all regulators.

- 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.

- 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.

- Takes samples of intermediates and finished products for each batch to obtain representative samples.

- Performs checking tests at random throughout processes for critical start-up tests and to check for correctness of printed materials and over printed items.

- Observes conditions on line and in-process area for compliance with the process method, for correct operation of procedures and for cleanliness and clearance of other components.

- Reports data to prepare a batch report on the key components used and their status, clearance and cleanliness in-process checks and general comments on conditions in the area and flow of process.

- Reviews the executed manufacturing batch records for completeness, correctness, compliance of in-process control results with specification and reporting of “unusual incidents”.

- Ensures production materials meet defined quality standards prior to disposition.

- Responsible for tracking and trending of out-of-specification results, failure investigation, nonconformance, deviations, change controls and complaints.

- Monitors Water station and environmental of production and material disposition areas.

- Communicating with patients suffering from chronic diseases like Diabetes, that we support in our programs and help patients to manage their disease to improve their quality of life.

- Increasing awareness of our patients about their diseases, if they are diabetic for example how to use their insulin delivery devices and how to handle problems if any.

- Motivate patients, using SANOFI products, to comply with their treating physician’s instructions regarding their medications, life style, etc.

- Giving educational sessions about diabetes through our centers.

- Handling any problems or Complaints that may arise from our Patients.

- Reporting the complaints to the concerned person & suspected adverse events to Pharmacovigilance manager.

- Handlings stocks and fulfill all inventories and paper work & cover dropped shifts.

- Co-operate with Medical & Marketing to cover Diabetes days as assigned per each area.

Others:
- Perform other duties as assigned.
- Respect of company’s values, code of ethics and social charter.
- Respect of personal data protection charter.
- Responsible for applying the HSE related requirements for the company in all related working procedures.

– Review and execute physician’s prescriptions checking their appropriateness and legality.

– Organize the pharmacy in an efficient manner to make the identification of products easier and faster.

– Maintain full control over delivering, stocking and labeling medicine and other products and monitor their condition to prevent expiring or deterioration.

– Listen carefully to customers to interpret their needs and issues and offer information and advice.

– Provide assistance other medical services such as injections, blood pressure/ temperature measurements etc.

– Prepare medicine when appropriate using correct dosages and material for each individual patient.

– Keep records of patient history and of all activities regarding heavy medication.

– Keep abreast of advancements in medicine by attending conferences and seminars and collaborating with other healthcare professionals.

– Comply with all applicable legal rules, regulations and procedures.