Job purpose The primary goal is to evaluate and authorise clinical cases and complex medical pre-authorisations. In addition to working closely with our UK domestic business to leverage knowledge, capability and process. Main Responsibilities To investigate, and respond to enquiries for complex medical pre-authorization and high-value claims from different internal and external shake holders including but not limited to members, providers, service providers and intermediaries in the appropriate method, in line with Bupa Global policy and management style Ensure the correct interpretation of Bupa Global's policies and rules, using the appropriate coding system to process the data and information accurately. Identify opportunities to reduce future claim expense for Bupa Global Proactively negotiate medical cost based on evidence to achieve either reduced cost to the business Proactively identify fraud and/or abuse and reports to appropriate parties Oversee member's progress and monitor the discharge plan drafted. Prepare documents and reports required for internal and external shake holders in the scope of case coordination activities and/ or data collections. Input clinical information into computer database, under the supervision of regional case manager Assist Regional Contracting Manager with projects in ad-hoc basis. The Ideal Candidate Bachelor Degree or above in healthcare or related discipline Doctor or RN experience with speciality (local or overseas) is preferred. OR At least 2 years of solid experience in utilization review or case management in IPMI environment. Knowledge of coding system is a must Excellent knowledge of Microsoft Word and Microsoft Excel is a must. Excellent interpersonal skills and ability to work with a team is a must Excellent analytical and critical thinking skills Respects diversity and embraces cultural difference Highly customer focussed and able to place customer's health and benefit in the first priority. Understand the business commitment to meet deadline and turn-around time Proficient communication skills in English About The Company Bupa's purpose is longer, healthier, happier lives. As a leading global health and care company, we offer health insurance, medical subscription and other health and care funding products; we run care homes, retirement and care villages, primary care, diagnostic and wellness centres, hospitals and dental clinics. We also provide workplace health services, home healthcare, health assessments and long-term condition management services. We have 32M customers globally. With no shareholders, we invest our profits to provide more and better healthcare and fulfil our purpose. We employ 86,000 people, principally in the UK, Australia, Spain, Poland, New Zealand and Chile, as well as Saudi Arabia, Hong Kong, India, and the USA. We have grown significantly, particularly through 2013 to 2015, when we accelerated execution of our strategic vision. We are similar in revenue and profit to Marks & Spencer, and larger than Heinz in revenue. Because Bupa does not have shareholders it does not have a listing, but if it did it would be in the FTSE 100. Bupa is not a mutual or a charity but a company limited by guarantee that seeks to maximise its profits in order to fulfil its purpose. With customers in virtually every country in the world and 70% of its revenues now generated outside the UK, Bupa is a truly international organisation. Bupa's Strategic Framework Our strategy has three pillars: Customers, People, Performance. It puts our customers front and centre in the context of today's digital age. As a service organisation, everything we do for our customers relies on our people and partners, so being a place where people love to work is critical to our success. This, combined with disciplined risk and capital management, is how we will deliver strong and sustainable performance. We are looking for individuals who share in our values and this strategy, and are capable of delivering outstanding results for the business. Bupa Global Bupa Global provides products and services worldwide to people who want access to premium health and care at home or as they study, live, travel or work abroad. We provide international health insurance, travel insurance and medical assistance to individuals, small businesses and global corporate customers all around the world. Bupa Global has over 1,800 employees and has offices in London and Brighton (UK), Miami (USA), Copenhagen (Denmark), Hong Kong (Greater China), and Dubai (UAE), as well as in Egypt, Mexico, the Dominican Republic, Bolivia, Panama, Guatemala and Ecuador. Bupa Global is currently organised around five regional hubs: Bupa Global Africa, India & Middle East; Bupa Global Greater China; Bupa Global Latin America; Bupa Global North America and Bupa Global Europe.