Manager - Pre Authorization

• Adjudicate the cases (In-Patient & Out-Patient) based on common medical practice and inline with Bupa protocols and policy .
• Ensure the decisions are according to the best medical standards and agreement terms & conditions in order to prevent abuse, fraud and overtreatment

• Ensure working with high quality of decision making with Zero QDI (Quality Demerit Index) A or B
• Ensure the medical decisions are consistent and are implemented based on clinical and practice guidelines signed off by the organization.
• Ensure high customer satisfaction in line with BUPA values and business strategy

• Ensure achieving the daily targets in terms of productivity & speed of response.
• Ensure proper interpretation and usage of clinical skills

• Report all high value claims as per agreed process.
• Highlight and report fraud, abuse, and anti-selection.
• Apply terms and conditions of BUPA declaration policy in SME products.
• Follow CCHI policy’s terms and conditions

• Constantly upgrade his knowledge and experience in order to meet challenges.
• Offer professional help to the rest of his team members.
• Provide positive feedback and help in solving problems

• Valid Saudi Commission
• Clinical experience in General practitioner / Emergency / Family Medicine
• Insurance experience preferable

Bupa