إرفاق
وصف الوظيفة
To ensure alignment with all decisions and regulations in terms of medical services provided and agreed contract within assigned providers are handled by the provider management, insurance office, and all stakeholders. Monitoring of Preauthorization standards regarding Customer experience and ensuring provider compliance
- Medical cost & Service Management
Monitoring of the processes agreed with the Provider are going in line with operational instructions
Providing guidance for the Insurance office and management inside providers to achieve best parameters for Customer experience improvement without cost impact.
- Quality medical decision & Patient safety
Ensure high-quality decisions regarding process handling and monitoring
Monitor customer satisfaction perception metrics inside Providers ( CSAT & TNPS ) .
Ensure a high level of communication with Providers, delivering best operational mutual agreements
Ensure applying terms and conditions of Bupa Policy
Adherence to CHI policy and regulations
Highlight and report fraud, abuse, and anti-selection
- Efficiency management
Monitor that the adjudicating requests and case management for PA team is as per accepted medical practice and as per Bupa medical protocol, thereby securing CX, and safety from medical abuse.
Ensure achieving the daily Targets in terms of productivity
Ensure proper interpretation and usage of clinical skills and operational excellence
Improve decision-making skills on an individual level
- Operation excellence
Process improvement initiatives to achieve excellence
Follow operational instructions and apply to relevant processes
- Capability Building & People Management
Ensure and facilitate goal setting of Customer excellence
Provide regular feedback, coaching and development
Motivate, encourage collaboration between internal and external stakeholders
- Support the business & communicate effectively
Discuss & report the high value claims and/or critical cases with involved parties
Take active part in complaint management and communicate effectively (inter/intra department)
Report any crisis and adhere to instructions related to it
المهارات
Language (English) and basic computer skills
Preference:
Clinical experience as General Practitioner / Emergency / Family Medicine
Medical insurance practice
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.
