وظيفة مدير خدمات الرعاية الصحية شاغرة لدى بوبا العربية في جدة

To resolve internal escalations of non-approved pre-authorization cases on time and restore member confidence through clear communication and coordinated clinical review.

End-to-End Escalation & Recovery Case Management

•            Handle internal escalations of non-approved pre-authorization cases.

•            Coordinate clinical review of escalated cases.

•            Coordinate with Medical, Operations and Customer Care to resolve cases on time.

•            Track open escalations to control the case backlog.

Member Recovery & Service Excellence

•            Conduct recovery reviews for predefined eligible cases.

•            Contact members to understand and address their concerns.

•            Communicate case outcomes to members clearly.

•            Follow up after adverse service experiences to restore member confidence.

Continuous Improvement & Root Cause Analysis

•            Analyse escalations, complaints and rework drivers to identify root causes.

•            Identify process gaps and improvement opportunities.

•            Recommend corrective and preventive actions for approval.

•            Coordinate agreed actions with cross-functional stakeholders.

•            Healthcare insurance operations and pre-authorization processes

•            Medical policy and benefit interpretation

•            Case management and service recovery methodologies

•            Customer experience and complaint management

•            Healthcare analytics and performance reporting

•            Quality assurance and root cause analysis

•            Process improvement and operational excellence

•            Data visualization and dashboard interpretation

•            Risk assessment and escalation management

•            Communication, stakeholder management and negotiation skills

Medicine and Surgery