Overview
Manager – Medical Pre Authorisation; Mega AC Jobs in Riyadh, Saudi Arabia at BUPA Arabia
Position: Manager – Medical Pre Authorisation (Mega AC)
To adjudicate inpatient and outpatient pre-authorization requests accurately and within approved clinical, regulatory, and policy standards, controlling medical expenditure while safeguarding member health and safety in line with Bupa values.
Responsibilities
- Adjudicate inpatient and outpatient pre-authorization cases in line with common medical practice, Bupa protocols, and policy.
- Apply the client agreement terms and conditions when reviewing each case.
Quality Medical Decisions & Patient Safety
- Make consistent, clinically sound decisions based on approved clinical and practice guidelines.
- Safeguard member health and safety throughout the pre-authorization process.
Service Efficiency
- Adjudicate cases promptly to maintain a responsive service to hospitals and members.
- Manage case volumes to sustain productivity and turnaround.
Compliance with Policy & Regulation
- Process authorizations in line with company policy and applicable regulations.
- Escalate high-value transactions and claims through the agreed process.
Fraud, Abuse & Anti-Selection Reporting
Identify and report suspected fraud, abuse, and anti-selection through the agreed channels.
Continuous Improvement
Contribute to medical and operational projects that improve the pre-authorization function.
#J-18808-Ljbffr
Title: Manager – Medical Pre Authorisation; Mega AC
Company: BUPA Arabia
Location: Riyadh, Saudi Arabia
Category: