Manager Medical Excellence Pre Authorization (Mega AC)📣 Job Ad

About Bupa Arabia and the Role

Bupa Arabia is seeking a Manager - Medical Excellence Pre Authorization (Mega AC) to join our team in Al Khobar. This full-time position is central to ensuring high standards in medical services and pre-authorization processes within our network.

Role Purpose

The primary purpose of this role is to ensure complete alignment with all decisions and regulations pertaining to medical services provided. This includes overseeing agreed contracts within assigned providers, with responsibilities extending to provider management, the insurance office, and all relevant stakeholders to maintain service quality and compliance.

Medical Cost, Service, and Quality Management

• Monitor pre-authorization standards to enhance customer experience and ensure provider compliance.
• Oversee processes agreed with providers to ensure alignment with operational instructions.
• Provide guidance to the insurance office and management within providers to improve customer experience parameters without increasing costs.
• Ensure high-quality decisions in process handling and monitoring.
• Monitor customer satisfaction perception metrics (CSAT & TNPS) within providers.
• Ensure adherence to Bupa Policy terms and conditions, as well as CHI policy and regulations.
• Identify and report instances of fraud, abuse, and anti-selection.

Operational Efficiency and Process Improvement

• Monitor the adjudication of requests and case management for the Pre-Authorization (PA) team, ensuring adherence to accepted medical practice and Bupa medical protocols to secure customer experience and prevent medical abuse.
• Achieve daily productivity targets.
• Ensure proper interpretation and application of clinical skills and operational excellence.
• Drive process improvement initiatives to achieve operational excellence.
• Follow operational instructions and apply them to relevant processes.
• Improve individual decision-making skills.

Stakeholder Engagement and Capability Building

• Maintain a high level of communication with providers, fostering optimal operational mutual agreements.
• Facilitate goal setting for customer excellence.
• Provide regular feedback, coaching, and development to team members.
• Motivate and encourage collaboration among internal and external stakeholders.
• Discuss and report high-value claims or critical cases with involved parties.
• Actively participate in complaint management and communicate effectively across departments.
• Report any crises and adhere to related instructions.

Application Information

If you are a dedicated professional ready to contribute to medical excellence and operational efficiency within a dynamic healthcare environment, we encourage you to apply for this full-time position.