Intake Care Representative

As an Intake Care Representative, you will be a member of the Provider Services Organisation (PSO) CARE Team servicing Global Health Benefits Europe, supporting the processing and management of Guarantees of Payment (GOPs) towards healthcare providers.

The CARE Team consists of non-clinically trained professionals who play an important role in ensuring that requests for treatment and hospitalization are reviewed and handled accurately and in a timely manner.

You will work closely with CARE Team colleagues across Madrid and Bengaluru, as well as with other internal teams involved in the management of the case.

Your role will involve reviewing healthcare requests from an administrative and coverage perspective, communicating with healthcare providers and insured members, gathering the information required to progress cases, and ensuring that requests requiring additional expertise are correctly referred to the appropriate internal teams.

Main Responsibilities

Guarantee of Payment & Case Management

• Be responsible, together with your colleagues, for the timely and accurate processing and sending of Guarantees of Payment (GOPs).
• Analyze requests for medical treatments and hospitalizations, including the requested treatment, amount and expected length of stay according to the applicable policy.
• Verify the patient’s extent of cover and relevant policy information.
• Review the relationship with the healthcare provider, the need for medical review and the costs associated with the request.
• Review and monitor cases from an administrative perspective throughout the required stages of the Intake process.
• Follow up on pending information and documentation required to progress the case.
• Maintain accurate and complete case information and documentation.
• Identify cases requiring additional review and cascade them to Case Coordination, Case Managers or Medical Advisors, depending on the applicable triggers.

Provider & Customer Communication

• Act as a point of contact for hospitals and healthcare providers regarding questions related to the Guarantee of Payment.
• Communicate regularly with medical providers and insured members, primarily by email and telephone.
• Obtain the necessary information and documentation from providers and insured members to support the correct processing of requests.
• Provide clear, accurate and professional communication while managing the request.
• Maintain a customer-focused approach when interacting with members, providers and internal stakeholders.

Collaboration & Operational Support

• Work collaboratively with other members of the CARE Team to ensure timely management of incoming requests.
• Collaborate effectively with the internal teams involved in the case management process.
• Ensure clear and accurate handovers when a case needs to be transferred or escalated to another team.
• Raise questions or cases requiring additional support through the appropriate channels.
• Contribute to a positive and collaborative working environment across locations.

Quality & Service Delivery

• Follow established procedures and operational guidelines when processing cases.
• Maintain high standards of accuracy and attention to detail.
• Effectively organize and prioritize assigned workload.
• Work within established deadlines and turnaround expectations.
• Ensure information entered in cases is clear, accurate and complete.
• Take ownership of assigned activities and follow up appropriately until the required action has been completed.
• Adapt to changes in processes, procedures and operational requirements.
• Contribute to a consistent and reliable service for members and healthcare providers.

Your Profile

Experience

• Fluent in English, both written and spoken. Additional languages are an advantage.
• Previous experience in a medical or healthcare environment is an advantage, but not required.
• Experience in customer service, administration, insurance or another service-oriented environment is beneficial.

Skills

• Strong analytical and problem-solving skills.
• Accurate and detail-oriented.
• Strong communication and customer service skills.
• Able to organize and prioritize workload effectively.
• Comfortable working against deadlines and handling time-sensitive requests.
• Able to work independently while recognizing when escalation or additional support is required.
• Strong team player, comfortable working in an international and multicultural environment.
• Adaptable and willing to learn new processes, systems and healthcare terminology.

Key Competencies

• Customer Focus
• Attention to Detail
• Communication
• Teamwork
• Accountability
• Planning & Prioritization
• Problem Solving
• Adaptability