Job description and KPI's

• Job grade - A
• Business Title - Member Services Advisor
• Advertising title - Customer Service Advisor
• Reports to - Service Team Manager
• Department - UK Insurance Operations - Customer Contact
• Location/Unit/Company - Bupa Place - Salford Quays

To provide a confident, knowledgeable and efficient front-line service to our Bupa customers via telephony (inbound and outbound) , Every call is different and the job holder will be responsible for establishing eligibility for the caller to use their insurance policy.

They will pre authorise or decline treatment in line with policy coverage, Signpost the customer to the services available through their Bupa policy, and were appropriate guide the customer along the most suitable treatment pathway.

This must be done in line with Key Performance Metrics for the role, including but not limited to -Customer experience, Quality Assurance outcomes , Colleague behaviours and other call handling metrics.

• To authorise customer treatment using the decision engine process.  This will involve obtaining the required information from the customer and using the system and associated information to reach correct authorisation decisions.
• To handle customer’s queries via telephony to resolve queries in line with Bupa policy and procedures.
• Guiding our members to ensure that they receive the correct treatment available in conjunction with their policy terms and conditions
• Proactively investigate and provide solutions to customer queries at first point of contact wherever possible.
• Act as an escalation point to other business areas/Clinicians for health cases deemed clinically complex and/or general Bupa policy queries.
• To ensure appropriate records of customer interactions are created and maintained on Bupa systems to remain compliant with data protection and regulatory requirements
• Continually look for ways to improve the service you provide to customers in every interaction
• To fully investigate and resolve, where possible, all queries and complaints from customers. If resolution is not possible, the member service adviser is responsible for following the appropriate escalation process within the complaints process timescales.
• To utilise current multiple Bupa systems and software proficiently as required by the role.
• To support colleagues in sharing information and knowledge in order to deliver the best possible outcomes for customers.
• To manage all customer contacts in line with regulatory requirements.

• 5 GCSE’s or equivalent or demonstrated good level of education in previous positions held.
• Previous experience of working in a customer services environment and demonstrates strong customer focus skills. Previous Contact Centre experience is essential.
• Must have ability to deal calmly and professionally with highly emotional, often vulnerable, anxious and worried customers within a pressurised environment.
• Must be resilient and able to keep difficult conversations and challenges in perspective, and understand not everything is eligible and you will need to decline some requests.
• Ability to handle telephone calls with knowledge, confidence, maturity and tact at all times.
• Ability to think analytically to determine the eligibility of benefit whilst managing own performance in line with Key Performance Metrics and Good Customer Outcomes
• Flexibility to adapt your way of working within a changing and challenging environment.
• Time management skills and the ability to work quickly and accurately.
• Ability to work on own initiative and make decisions within the protocols set down with minimum supervision.
• Good problem-solving skills with the ability to present solutions to problems.
• Ability to remain positive and calm and approaches work with a “can do” attitude.
• Must be able to consistently display the Bupa Values through your conduct and behaviour, Being Brave, Caring and Responsible.
• Ability to tailor your approach to each customer through effective conversation and listening skills, balancing great customer service delivery with efficient performance.
• PC literate with good knowledge of Windows based packages. Must have the ability to combine talking and typing skills across a variety of systems at the same time, this is essential.
• Excellent communication skills, including both telephone and Email writing skills, and the ability to deal effectively with internal and external customers of all levels.

Identify and be proactive in acting to quickly resolve any problems.  This involves taking ownership for the call and requesting additional information such as where policy and process indicate this is required, liaising with members and referrals to other departments to ensure the speedy resolution of the members query.

The job holder is expected in most instances to make decisions based on the information gathered, within the guidelines/protocols set, but if this is not possible, he/she is responsible for providing a full case history to the Service Team Manager if the query has to be escalated and further review is required

• The jobholder works under the supervision of a Service Team Manager, who is responsible to monitoring both the quantity and quality of the jobholders’ work.  However, within these parameters, the job holder is responsible for managing their own workload to ensure the accurate and timely resolution of members’ queries in line with outlined Key Performance Metrics.  They are empowered to use their initiative to resolve members’ queries/problems, in accordance with the policies and protocols set by the department.
• The jobholder has the authority, within set guidelines, to adjust claims that have already been processed by the claims department which has financial implications where an error has been identified in the original processing of the claim.
• To use a variety of tools and systems to take the appropriate action for the customer based on the information they have provided, across a variety of specialisms

*Working location *
Your location depends on your role applied for. You may be Hybrid/Office Based/ Homeworking

Where you are working at home this will only be possible if you can demonstrate effective and efficient ability to work from home, and a stable and secure working environment and wired internet connection.
Where your role is not Homeworking you will be expected to be present in the office for the first 10 weeks of your role during your training and academy.
For all MSA roles mandatory office attendance could be requested in the event of network or system issues
This is subject to change at any point and will be reviewed regularly.

The jobholder will be held responsible for enforcing Data Protection guidelines with reference to customer confidentiality.

The jobholder does not have any direct reports and does not have any responsibility for the management of budgets.

The jobholder will work in a pressurised volume and quality driven environment and within this, he/she will have to work to measures everyday, which are set by the Service Leader/Department.  He/she will have knowledge of the other areas in UK Service and build relationships with other departments, particularly claims, to ensure that members’ queries/problems can effectively and promptly be dealt with and resolved.

Therefore, helping to deliver and maintain the expected standard of work in line with our Best Practices. When working from Home must have appropriate wired connection and systems to support effective delivery of MSA duties.

The role is located in either Salford Quays/Homeworking

Senior Customer Manager

Customer Service Manager / Operational Manager

Service Team Manager

Member Services Advisor

You should be able to demonstrate that you pay due regard to customers and treat them fairly by:

• Being able to explain the impact that your role and actions have on the fair treatment of customers.
• Being able to explain the potential implications for customers who are not treated fairly by you or others.
• Making the fair treatment of customers central to all that you do.
• Always seeking to be competent to do your job e.g. by completing all compulsory regulatory training on time to ensure that you have all the necessary knowledge and skills.
• Always providing customers with clear information and suitable advice which takes account of their circumstances.