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Job Description
- Adjudicate the cases (In-Patient & Out-Patient) based on common medical prcatice and inline 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
High quality medical decision & patient safety
- 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
Efficiency management
- Ensure achieving the daily targets in terms of productivity & speed of response.
- Ensure proper interpretation and usage of clinical skills
Compliance to policy and Regulation
- 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
Support & contribute in capability building
- Constantly upgrade his knowledge and experience in order to meet challenges.
- Offer professional help to the rest of his team members.
- Provide positive feedback and help in solving problems
Skills
- Valid Saudi Commission
- Clinical experience in General practitioner / Emergency / Family Medicine
- Insurance experience preferable
- Minimum 3 years of clinical experience excluding internship year.
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.