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Job Description
Ensure clinically appropriate, evidence-based preauthorization decisions through effective utilization management, regulatory compliance, and provider engagement, while safeguarding patient outcomes, enhancing customer experience, and optimizing healthcare resource utilization.
Medical Cost & Service Management
• Apply evidence-based medicine, clinical guidelines, and policy terms during preauthorization review.
• Ensure appropriate utilization of healthcare services while preventing unnecessary costs.
• Support cost-containment initiatives through effective medical adjudication and utilization management.
Quality Medical Decision & Patient Safety
• Ensure clinically sound and consistent medical decisions.
• Monitor decision quality and adherence to medical protocols.
• Promote provider satisfaction through effective communication and partnership management.
Business Support & Stakeholder Management
• Manage and escalate high-value, complex, or critical cases when required.
• Participate in complaint resolution and support business continuity efforts.
• Maintain effective communication with internal and external stakeholders.
• Report operational risks and critical incidents in a timely manner.
Compliance, Governance & Risk Management
• Ensure adherence to Bupa policies, medical protocols, and regulatory requirements.
• Comply with CHI regulations and governance standards.
• Identify, escalate, and report suspected fraud, waste, abuse, and anti-selection activities.
• Support audit readiness and compliance monitoring activities.
Skills
Minimum 3 years of Experience – Medical
Clinical experience as General Practitioner / Emergancy / Family Medicine
Medical insurance practice
Language (English) and basic computer skills
Bachelor’s in medicine or equivalent
Postgraduate in Medicine and surgery
2 years’ experience at least in medical field ( Hospital practicing ) or at insurance field
Education
Medicine and Surgery
Job Details
Preferred Candidate
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.
