بوبا العربية تعلن عن وظيفة مدير التصريح المسبق الطبي في الرياض

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.

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.

·        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.

·        Strong communication skills.

·        3 - 5 years.