ClaimsPaymentIntegrityConsultant

Job Description: Job Description **Claims Payment Integrity Consultant** **Cairo, Egypt** **Hybrid** **We make health happen:** As a Claims Payment Integrity Consultant you will be directly support Bupa Global’s payment integrity strategy. This role will ensure the integrity of claims paid by Bupa Global by acting as a control to mitigate the payment of false claims by verifying the validity of member and provider records. This role is also to ensure that payments are made to the correct payee and bank account information as wrong payments result in a loss to the business. **Key Responsibilities:** * You will be responsible for the review and sign off of new bank account information added to SWAN where there is an * attempt to pay a claim. This will include in network, out of network and member paid claims. * You will be reviewing provider information for new providers who are not yet stored in the SWAN system. This will include a review, research and requesting information to establish the validity of the provider. * You will be responsible for adding new and valid providers to the SWAN system ensuring full contact information is captured and the provider record is accurate. * You will be responsible for the review of out of network providers already in SWAN generated via claims rules. This will include a review, research and requesting information to establish the validity of the provider. * You will be responsible for referring none valid providers to the Counter Fraud Team where there is evidence the provider is false or did not provide the treatment. You will also be responsible for rejecting claims where you have been unable to verify the provider information. * You will respond directly to any relevant incoming replies from our customers when they provide us with additional information related to their claims. * You will be actively validating potential fraudulent member/provider behaviour and referring them to the counter fraud, waste and abuse team where ap