الصفحة الرئيسية المملكة العربية السعودية Manager - Pre-Authorization (Pipeline)
الصفحة الرئيسية المملكة العربية السعودية Manager - Pre-Authorization (Pipeline)
Manager - Pre-Authorization (Pipeline)
تفاصيل الوظيفة
Manager - Pre-Authorization (Pipeline) Job Description To ensure medical spend (In-Patient & Out-Patient services) is controlled by ensuring that pre-authorization decisions are within defined SAMA & CCHI regulations, accepted guidelines and high-quality medical standards, safeguarding the member's health & safety and aligned to BUPA Values. Medical Cost & Service Management
- Adjudicate the cases (In-Patient & Out-Patient) based on common medical practice and in line with Bupa protocols and policy.
- Ensure the decisions are according to the best medical standards and agreement terms & conditions in order to prevent abuse, fraud, and overtreatment.
- Ensure working with high quality of decision making with Zero QDI (Quality Demerit Index) A or B.
- Ensure the medical decisions are consistent and are implemented based on clinical and practice guidelines signed off by the organization.
- Ensure high customer satisfaction in line with BUPA values and business strategy.
- Ensure achieving the daily targets in terms of productivity & speed of response.
- Ensure proper interpretation and usage of clinical skills.
- Report all high value claims as per agreed process.
- Highlight and report fraud, abuse, and anti-selection.
- Apply terms and conditions of BUPA declaration policy in SME products.
- Follow CCHI policy’s terms and conditions.
- Constantly upgrade knowledge and experience in order to meet challenges.
- Offer professional help to the rest of the team members.
- Provide positive feedback and help in solving problems.
- Valid Saudi Commission.
- Clinical experience in General Practitioner / Emergency / Family Medicine.
- Insurance experience preferable.
- Minimum 3 years of clinical experience excluding internship year.
Apply safely
To stay safe in your job search, information on common scams and to get free expert advice, we recommend that you visit SAFERjobs, a non-profit, joint industry and law enforcement organization working to combat job scams.
الشركة المعلنة عن الوظيفة
Saudi Petroleum Services Polytechnic
Similiar Jobs that might interest you
BARGE CAPTAIN - OFFSHORE SAUDI ARABIA
Team Recruitment Ltd... of Offshore Marine vessels/Drilling Rigs as a barge supervisor ... as a Captain or senior officer on offshore drilling rigs ...
Saudi Arabia - Dammam 4 أيام مضت
Electrical Engineer
Saudi Aramco... in the Kingdom of Saudi Arabia, and with offices around ... of the Kingdom of Saudi Arabia. Your primary role will ...
المملكة العربية السعودية 4 أيام مضت
Polyolefin Engineer
Saudi Aramco... . Headquartered in the Kingdom of Saudi Arabia, and with offices around the ...
المملكة العربية السعودية 4 أيام مضت
Plant Corrosion Engineer
Saudi Aramco... . Headquartered in the Kingdom of Saudi Arabia, and with offices around the ...
المملكة العربية السعودية 4 أيام مضت
Plant Corrosion Engineer
Saudi Aramco (ASC)... . Headquartered in the Kingdom of Saudi Arabia, and with offices around the ...
المملكة العربية السعودية 4 أيام مضت
Corrosion Engineer
Saudi Aramco (ASC)... in the Kingdom of Saudi Arabia, and with offices ... Engineering standards within Saudi Aramco & international standards ...
المملكة العربية السعودية 4 أيام مضت
Corrosion Engineer
Saudi Aramco... in the Kingdom of Saudi Arabia, and with offices ... Engineering standards within Saudi Aramco & international standards ...
المملكة العربية السعودية 4 أيام مضت
Corrosion Engineer
Saudi Aramco (ASC)... in the Kingdom of Saudi Arabia, and with offices ... operating facilities as per Saudi Aramco and international standards ...
المملكة العربية السعودية 4 أيام مضت
Corrosion Engineer
Saudi Aramco... in the Kingdom of Saudi Arabia, and with offices ... operating facilities as per Saudi Aramco and international standards ...
المملكة العربية السعودية 4 أيام مضت
Assistant Mechanic
Parker Wellbore... be able to obtain appropriate offshore or, onshore certifications o Should ...
Saudi Arabia - Dammam 4 أيام مضت
Service Technician 1
Parker WellboreCompany Description At Parker Wellbore, we pride ourselves on providing safe, efficient, and reliable drilling ...
Saudi Arabia - Dammam 4 أيام مضت
Corporate Executive
Spemocean... Position: Corporate Executive - Saudi Regulatory Experience Location: ... in navigating Saudi Arabia's regulatory landscape ...
المملكة العربية السعودية 4 أيام مضت
Internal Security Investigator
Saudi Aramco (ASC)... in the Kingdom of Saudi Arabia, and with offices around ... and consulting services to Saudi Aramco's Corporate and ...
المملكة العربية السعودية 4 أيام مضت
Internal Security Investigator
Saudi Aramco... in the Kingdom of Saudi Arabia, and with offices around ... and consulting services to Saudi Aramco's Corporate and ...
المملكة العربية السعودية 4 أيام مضت
Quality Engineer
NES FircroftRole- QUALITY ENGINEER Job Location - KSA (On NES Payroll) NES Fircroft is a world's leading recruitment firm for ...
المملكة العربية السعودية 4 أيام مضت
Sr Counsel - Subsidiary Secretariat & Governance Legal Practice
Saudi Aramco (ASC)... affiliated entities. Headquartered in Dhahran, Saudi Arabia, Counsel will join the Subsidiary ...
المملكة العربية السعودية 4 أيام مضت
Economic Analyst
Saudi Aramco (ASC)... . Headquartered in the Kingdom of Saudi Arabia, and with offices around the ...
المملكة العربية السعودية 4 أيام مضت
Intellectual Property Licensing & Transactions Expert
Saudi Aramco (ASC)... . Headquartered in the Kingdom of Saudi Arabia, and with offices around the ...
المملكة العربية السعودية 4 أيام مضت
Fuels Expert
Saudi Aramco (ASC)... . Headquartered in the Kingdom of Saudi Arabia, and with offices around the ...
المملكة العربية السعودية 4 أيام مضت
لماذا تقوم بالإبلاغ عن هذه الوظيفة؟
Job has expired لا يمكن عرض هذه الصفحةبدلًا من ذلك، يمكنك النقر على الرابط أدناه أو نسخ/لصق الرابط في متصفح الإنترنت الخاص بك.
https://sa.jooble.org/external/9164851514827266194?cpc=d0FU&utm_source=affiliate&utm_medium=laimoon_organic_sa&extra_ars_request_id=d9de1c9104445c9c6a6ba7b1d970e9e9