Manager - Medical Pre Authorisation (Mega AC)

Bupa Arabia
Riyadh
Workplace: OnsiteFull timeFunction: Healthcare (Clinical, Medical, Wellness)Experience: 3-5 yearsEducation: bachelorsSkills: ["Communication","Working under pressure"]

Adjudicate inpatient and outpatient pre-authorization requests to ensure decisions are accurate and aligned with approved clinical practice, Bupa protocols, and policy. Manage medical cost and service performance by processing cases promptly, maintaining productivity, and applying contract terms. Ensure patient safety through clinically sound decision-making, process authorizations according to regulations, escalate high-value items, report suspected fraud, and support continuous improvement projects.

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FursaFursa
Bupa Arabia
Bupa Arabia
6 days ago

Manager - Medical Pre Authorisation (Mega AC)

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Source: Company careers pageValidated by: Fursa AI
Last checked: 4 hours agoStatus: Live

Job Summary

Adjudicate inpatient and outpatient pre-authorization requests to ensure decisions are accurate and aligned with approved clinical practice, Bupa protocols, and policy. Manage medical cost and service performance by processing cases promptly, maintaining productivity, and applying contract terms. Ensure patient safety through clinically sound decision-making, process authorizations according to regulations, escalate high-value items, report suspected fraud, and support continuous improvement projects.
Location: Riyadh
Workplace: Onsite
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Manager level

Key Responsibilities

  • •Adjudicate inpatient and outpatient pre-authorization cases per common medical practice, Bupa protocols, and policy.
  • •Apply client agreement terms and conditions when reviewing each case.
  • •Make consistent, clinically sound decisions using approved clinical and practice guidelines while safeguarding member health and safety.
  • •Adjudicate cases promptly and manage case volumes to sustain productivity and turnaround for hospitals and members.
  • •Process authorizations in line with company policy and applicable regulations, escalate high-value transactions, and report suspected fraud, abuse, and anti-selection; contribute to continuous improvement projects.

Key Requirements

  • •Bachelor's degree in MBBS.
  • •Clinical experience in General Practice, Emergency, or Family Medicine.
  • •Ability to conduct business in the English language.
  • •Ability to work under pressure.
  • •3–5 years of experience.
Experience:3-5 years
Education:Bachelor's
Skills:CommunicationWorking under pressure
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