Medical Roles (Jeddah)

#

Key Accountabilities

Key Activities / Decision Areas

1

Medial cost & Service Management

·          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.

2

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.

3

Efficiency management

·         Ensure achieving the daily targets in terms of productivity & speed of response.

·         Ensure proper interpretation and usage of clinical skills.

4

Compliance to policy and Regulation

·         Report all high value calims 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.

5

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.