إرفاق
وصف الوظيفة
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.
المهارات
• 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
المؤهلات العلمية
Medicine and Surgery
تفاصيل الوظيفة
المرشح المفضل
Bupa Arabia
Bupa Arabia is a healthcare insurance company based in the Kingdom of Saudi Arabia. We are an associate business of Bupa Group, which is a global healthcare company with an international reach that extends across multiple business operations, practices, and resources.
Founded in October 1997, Bupa Arabia was initially established through a partnership between Bupa Global International and Nazer Group, with the key focus to provide health insurance services with high quality and competitive prices, while ensuring a distinctive experience for customers. Bupa Arabia has since evolved into a fully Saudi-owned and operated company. Our transformation from a joint venture into a publicly traded company on the Saudi Stock Exchange occurred in 2008, as we made 40% of our shares available to the public during our Initial Public Offering (IPO).
As a subsidiary of the global Bupa Group, we draw upon international expertise while maintaining a profound understanding of local healthcare requirements and regulations. This allows us to offer comprehensive healthcare insurance solutions tailored to the unique needs of the Saudi Arabian market.
Bupa Arabia prides itself on its commitment to the wellbeing and development of its employees, providing them with the same standard of care, support, and professionalism that it expects to be delivered to its customers.
Our core values shape every aspect of our work and culture:
Commit – Own it with accountability and urgency.
Collaborate – Win together through cross-functional synergy.
Care – Put people first, both employees and customers.