Manager - Medical Pre Authorisation

Bupa Arabia
Jeddah
Workplace: OnsiteFull timeFunction: Healthcare (Clinical, Medical, Wellness)Experience: 3+ yearsEducation: mastersSkills: ["Evidence-based decision-making","Provider communication","Stakeholder management","Regulatory compliance","Risk awareness"]

Lead clinically appropriate, evidence-based preauthorization decisions by applying medical guidelines, clinical policies, and utilization management to ensure patient safety and cost-effective care. Oversee medical decision quality, monitor adherence to protocols, and manage/escalate complex cases. Partner with providers and internal teams to resolve complaints, report operational risks and incidents, and support audit readiness while complying with CHI regulations and Bupa governance standards.

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FursaFursa
Bupa Arabia
Bupa Arabia
4 days ago

Manager - Medical Pre Authorisation

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Source: Company careers pageValidated by: Fursa AI
Last checked: 8 hours agoStatus: Live

Job Summary

Lead clinically appropriate, evidence-based preauthorization decisions by applying medical guidelines, clinical policies, and utilization management to ensure patient safety and cost-effective care. Oversee medical decision quality, monitor adherence to protocols, and manage/escalate complex cases. Partner with providers and internal teams to resolve complaints, report operational risks and incidents, and support audit readiness while complying with CHI regulations and Bupa governance standards.
Location: Jeddah
Workplace: Onsite
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Manager level

Key Responsibilities

  • •Apply evidence-based medicine, clinical guidelines, and policy terms during preauthorization review.
  • •Ensure appropriate utilization of healthcare services and support cost-containment via medical adjudication.
  • •Ensure clinically sound, consistent medical decisions; monitor decision quality and adherence to medical protocols.
  • •Manage and escalate high-value, complex, or critical cases; support complaint resolution and business continuity.
  • •Ensure compliance with Bupa policies, medical protocols, and CHI regulations; identify and escalate fraud/waste/abuse and support audit readiness.

Key Requirements

  • •Minimum 3 years of medical clinical experience as a General Practitioner, Emergency, or Family Medicine practitioner.
  • •At least 2 years of experience in a hospital practice or in medical insurance.
  • •Bachelor’s in medicine or equivalent, with postgraduate Medicine and Surgery education.
  • •Proficiency in English and basic computer skills.
  • •Knowledge of medical insurance practice and evidence-based clinical decision-making.
Experience:3+ yearsHealthcareMedical insurance
Education:Master's in Medicine and Surgery
Skills:Evidence-based decision-makingProvider communicationStakeholder managementRegulatory complianceRisk awareness
Languages:English

Company Brief

Bupa Arabia
Provides health insurance products and managed healthcare services in Saudi Arabia for individuals and corporate clients. The company focuses on coverage administration, medical network access, and digital health support for members.
Industry: Health Insurance (Payers)
Company Size: Large (251 to 1,000 employees)
Growth: Public Company
Valuation: Public Company (Market Cap in USD)
Funding: IPO / Publicly Listed
Headquarters: Jeddah, Saudi Arabia
Founded: 1997
WebsiteLinkedIn