Manager - Medical Pre Authorisation

Job Description Ensure clinically appropriate, evidence-based preauthorization decisions through effective utilization management, regulatory compliance, and provider engagement, while safeguarding patient outcomes, enhancing customer experience, and optimizing healthcare resource utilization. Medical Cost & Service Management - Apply evidence-based medicine, clinical guidelines, and policy terms during preauthorization review. - Ensure appropriate utilization of healthcare services while preventing unnecessary costs. - Support cost-containment initiatives through effective medical adjudication and utilization management. Quality Medical Decision & Patient Safety - Ensure clinically sound and consistent medical decisions. - Monitor decision quality and adherence to medical protocols. - Promote provider satisfaction through effective communication and partnership management. Business Support & Stakeholder Management - Manage and escalate high-value, complex, or critical cases when required. - Participate in complaint resolution and support business continuity efforts. - Maintain effective communication with internal and external stakeholders. - Report operational risks and critical incidents in a timely manner. Compliance, Governance & Risk Management - Ensure adherence to Bupa policies, medical protocols, and regulatory requirements. - Comply with CHI regulations and governance standards. - Identify, escalate, and report suspected fraud, waste, abuse, and anti-selection activities. - Support audit readiness and compliance monitoring activities. Skills Minimum 3 years of Experience – Medical Clinical experience as General Practitioner / Emergancy / Family Medicine Medical insurance practice Language (English) and basic computer skills Bachelor’s in medicine or equivalent Postgraduate in Medicine and surgery 2 years’ experience at least in medical field ( Hospital practicing ) or at insurance field Education Medicine and Surgery

• Manager - Medical Excellence Pre Authorization (Mega AC)

  Bupa Arabia · Al Khobar, Eastern, Saudi Arabia