Manager - Medical Excellence Pre Authorization (Mega AC)

Bupa Arabia
Saudi Arabia
Workplace: OnsiteFull timeFunction: Healthcare (Clinical, Medical, Wellness)Education: bachelorsSkills: ["Communication","Coaching","Collaboration","Customer experience focus","Decision-making"]

Manage medical excellence for pre-authorization across assigned providers by monitoring standards, ensuring provider compliance, and improving customer experience without cost impact. Own high-quality medical decisioning and patient safety, track CSAT/TNPS metrics, and maintain strong provider communication and mutual operational agreements. Lead fraud, abuse, and anti-selection reporting, drive PA team efficiency and target achievement, and coach teams to improve operational decision-making.

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FursaFursa
Bupa Arabia
Bupa Arabia
7 hours ago

Manager - Medical Excellence Pre Authorization (Mega AC)

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Source: Company careers pageValidated by: Fursa AI
Last checked: 6 hours agoStatus: Live

Job Summary

Manage medical excellence for pre-authorization across assigned providers by monitoring standards, ensuring provider compliance, and improving customer experience without cost impact. Own high-quality medical decisioning and patient safety, track CSAT/TNPS metrics, and maintain strong provider communication and mutual operational agreements. Lead fraud, abuse, and anti-selection reporting, drive PA team efficiency and target achievement, and coach teams to improve operational decision-making.
Location: Saudi Arabia
Workplace: Onsite
Employment Type: Full time
Job Function: Healthcare (Clinical, Medical, Wellness)
Seniority: Manager level

Key Responsibilities

  • •Ensure alignment with decisions and regulations for medical services and agreed contracts across assigned providers.
  • •Monitor preauthorization standards, provider compliance, and processes against operational instructions and Bupa medical protocols.
  • •Provide guidance to the insurance office and providers to improve customer experience with no cost impact.
  • •Ensure high-quality medical decisions and patient safety, monitor CSAT/TNPS metrics, and maintain operational mutual agreements with providers.
  • •Lead efficiency and capability building for the PA team: oversee adjudicating requests/case management, achieve daily targets, and support complaint and crisis management.

Key Requirements

  • •Bachelor's degree.
  • •Clinical experience as General Practitioner / Emergency / Family Medicine.
  • •Experience in medical insurance practice.
  • •English language and basic computer skills.
  • •Ability to guide providers and internal teams to achieve customer excellence parameters.
Experience:HealthcareMedical insurancePatient safetyPre-authorizationProvider management
Education:Bachelor's
Skills:CommunicationCoachingCollaborationCustomer experience focusDecision-making
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