Manager Operational Transformation

About the Role

Bupa Arabia is seeking a Manager - Operational Transformation to oversee Pre-Authorization protocols, operational processes, and the execution of the Bupa Pro project. This full-time role, based in Riyadh, involves managing medical services and ensuring compliance with agreed contracts for assigned providers, including those handled by provider management, the insurance office, and the Bupa PA team. The objective is to achieve customer experience excellence, control costs, safeguard member health, and comply with SAMA, CHI Regulations, and BUPA values.

Key Responsibilities

• Manage Bupa Pro projects, closely monitoring medical services provided, operation process flow, and customer journey.
• Oversee relationships with providers concerning PA Protocol implementations to ensure optimal customer experience without cost impact.
• Ensure all cases handled by the team adhere to common medical practice and align with BUPA protocols and policy.
• Verify that decisions made by the team or processed by the insurance office comply with agreement terms and conditions to prevent abuse, fraud, and overtreatment.
• Ensure high customer satisfaction within the Bupa Pro scope, consistent with BUPA values, business strategy, and agreed provider protocols.
• Ensure compliance with SAMA and CHI regulations during medical adjudication.
• Confirm that medical decisions are consistent and implemented based on organization-approved clinical and practice guidelines.
• Monitor and ensure medical services case management is handled according to agreed processes.

Operational Efficiency and Quality

• Monitor that adjudicating requests and case management for the PA team follow accepted medical practice and Bupa medical protocol, ensuring customer experience and safety from medical abuse.
• Document all hospital field visits with targeted outcomes.
• Improve individual decision-making skills and support knowledge transfer to providers.
• Lead process improvement initiatives to achieve operational excellence.
• Guide the team in effective communication with hospitals and Bupa stakeholders to ensure service delivery.

Team Leadership and Development

• Facilitate goal setting and regularly review service performance.
• Provide consistent feedback, coaching, and development to direct reports.
• Motivate, empower, and enable direct reports by providing necessary tools and support.

Business Support and Compliance

• Actively participate in the reporting process for the Bupa Pro project.
• Report any deviations from agreements or critical cases to involved parties.
• Engage in complaint management and ensure effective inter/intra-departmental communication.
• Manage crises effectively based on established business continuity plans.
• Ensure adherence to Bupa and CHI policy terms and conditions.
• Highlight and report instances of fraud and abuse in collaboration with the PA Ops and utilization team.

Qualifications and Experience

Candidates should possess 3-5 years of relevant experience to effectively manage the responsibilities outlined for this role.