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Manager - Pre Authorization (Pipeline)
BUPA ArabiaJeddah, Makkah Region, Saudi Arabia30+ days ago
Job descriptionMaintain high-quality decision-making with Zero QDI (Quality Demerit Index) A or B. Ensure medical decisions are consistent and based on clinical and practice guidelines approved by the organization. Achieve high customer satisfaction in line with BUPA values and business strategy. Meet daily productivity and response speed targets. Properly interpret and utilize clinical skills. Report all high-value claims as per the agreed process. Highlight and report fraud, abuse, and anti-selection. Apply terms and conditions of BUPA declaration policy in SME products. Follow CCHI policy terms and conditions. Continuously upgrade knowledge and experience to meet challenges. Offer professional help to team members. Provide positive feedback and assist in problem-solving. Clinical experience in General Practice / Emergency / Family Medicine. Insurance experience is preferable. Minimum 3 years of clinical experience excluding internship year.
Jeddah, Saudi Arabia
Posted 2 days ago
Expires in 2 months
To ensure medical spend (In-Patient & Out-Patient services) is controlled by ensuring that pre-authorization decisions are within defined SAMA & CCHI regulations, accepted guidelines, and high-quality medical standards, safeguarding the member's health & safety, and aligned with BUPA Values.
Medical Cost & Service Management
- Adjudicate cases (In-Patient & Out-Patient) based on common medical practice and in line with Bupa protocols and policies.
- Ensure decisions adhere to the best medical standards and agreement terms & conditions to prevent abuse, fraud, and overtreatment.
High-Quality Medical Decision & Patient Safety
Compliance to Policy and Regulation
Support & Contribute to Capability Building
Skills
Job Role : Medical, Healthcare, and Nursing
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Manager • Jeddah, Makkah Region, Saudi Arabia
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