Manager - Medical Pre Authorisation (Mega AC)
- المدينة
- الرياض
- نوع العمل
- حضوري
- تاريخ النشر
- لم تذكره جهة العمل
- المجال
- القطاع الصحي
عن الوظيفة
To adjudicate inpatient and outpatient pre-authorization requests accurately and within approved clinical, regulatory, and policy standards, controllingmedical expenditure while safeguarding member health and safety in line with Bupa values.
Medical Cost & Service Management: · 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.
اقرأ الوصف كاملاً
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.
Job Details Posted Date: 2026-09-30 Job Location: Saudi Arabia - Riyadh Job Role: Other Preferred Candidate Career Level / Band: Junior Management Minimum Degree: Bachelor's degree