Manager Operational Transformation

About the Role

Bupa Arabia is seeking a Manager Operational Transformation to join their team in Riyadh, Saudi Arabia. This full-time role focuses on managing Pre-Authorization protocols and the execution of the Bupa Pro project, ensuring medical services and contract compliance within assigned providers. The objective is to enhance customer experience, control costs, safeguard member health, and ensure adherence to SAMA, CHI Regulations, and BUPA values.

Key Responsibilities

• Manage Bupa Pro projects, monitoring medical services and customer journeys, and overseeing provider relationships related to PA Protocol implementations to ensure customer experience excellence without cost impact.
• Ensure all cases handled by the team align with common medical practice, BUPA protocols, and policy guidelines.
• Verify that decisions made by the team and processed by the insurance office comply with agreement terms and conditions to prevent abuse, fraud, and overtreatment, while maintaining customer experience.
• Ensure high customer satisfaction under the Bupa Pro scope, in line with BUPA values, business strategy, and agreed provider protocols.
• Ensure compliance with SAMA and CHI regulations during medical adjudication processes.
• Ensure medical decisions are consistent and implemented based on clinical and practice guidelines approved by the organization.
• Oversee that medical services case management is handled according to agreed processes.

Operational Efficiency and Quality

• Monitor adjudication requests and case management for the PA team to ensure adherence to accepted medical practice and Bupa medical protocols, securing customer experience and preventing medical abuse.
• Ensure all hospital field visits are documented with targeted outcomes.
• Contribute to process improvement initiatives to achieve operational excellence.
• Lead communication efforts with hospitals and Bupa stakeholders to ensure effective service delivery.

Team Leadership and Development

• Facilitate goal setting and continuously review service performance for direct reports.
• Provide regular feedback, coaching, and development opportunities to team members.
• Motivate, empower, and enable direct reports by providing necessary tools and support.

Business Support and Communication

• Actively participate in the reporting process for the Bupa Pro project.
• Report any deviations from agreements or critical cases to relevant parties.
• Engage in complaint management and ensure effective communication across departments.
• Manage crises effectively based on established business continuity plans.

Qualifications and Experience

• A minimum of 5 to 10 years of relevant experience is required for this role.
• Strong understanding of Bupa and CHI policy terms and conditions.
• Ability to identify and report fraud and abuse in cooperation with PA Operations and utilization teams.