Manager Medical Pre Authorisation (Mega AC)

About the Role

Bupa Arabia is seeking a Manager Medical Pre Authorisation (Mega AC) to join their team in Riyadh, Saudi Arabia. This full-time position is integral to managing medical pre-authorization requests, ensuring adherence to clinical and regulatory standards while maintaining service efficiency.

Role Purpose

The primary purpose of this role is to accurately adjudicate inpatient and outpatient pre-authorization requests. This involves operating within approved clinical, regulatory, and policy standards, with a focus on controlling medical expenditure and safeguarding member health and safety in alignment with Bupa's values.

Key Responsibilities

• Adjudicate inpatient and outpatient pre-authorization cases in accordance with common medical practice, Bupa protocols, and policy.
• Apply the client agreement terms and conditions when reviewing each case.
• Make consistent, clinically sound decisions based on approved clinical and practice guidelines.
• Safeguard member health and safety throughout the pre-authorization process.
• Adjudicate cases promptly to maintain a responsive service to hospitals and members.
• Manage case volumes to sustain productivity and turnaround.
• Process authorizations in line with company policy and applicable regulations.
• Escalate high-value transactions and claims through the agreed process.
• Identify and report suspected fraud, abuse, and anti-selection through the agreed channels.
• Contribute to medical and operational projects that improve the pre-authorization function.

Experience Requirements

Candidates for this position should possess 5 to 10 years of relevant experience in medical pre-authorization or a related field.

Work Environment

This is a full-time position based in Riyadh, Riyadh, Saudi Arabia, requiring a dedicated presence to manage the complexities of medical pre-authorization processes.

Application Process

Interested candidates are invited to apply, demonstrating their experience and alignment with the responsibilities outlined for this critical role at Bupa Arabia.