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Nurse (Pipeline)

Jeddah , Saudi Arabia Posted 2023/09/28 08:46:11 Expires 2023-11-01 Ref: JB1100039593

Job Description

Ensure medical cost control through managing benefit spend for Out Patient services ONLY, making sure that decisions are within defined SAMA & CCHI regulations, accepted guidelines and high quality common medical standards safe guarding the member's health & safety and in line with Bupa Values.


Key Accountabilities

  • Adjudicate the Out Patient Cases based on common medical practice and inline with Bupa protocols and policy . 
  • Ensure the decisions are according to the best medical standards and agreements' terms  & conditions in order to prevent abuse, fraud and overtreatment    
  • Ensure member safety through working with High Quality of decision making with Zero QDI (Quality Demerit Index) A or B
  • Ensure the medical decisions are consistent and proper implementation of the clinical and practice guidelines signed off by the organization    
  • Ensure achiving of daily targets in terms of productivity & speed of response
  • Ensure proper interpretation and usage of clinical skills
  • Report all high Value calims as per agreed process with in Out Patient services
  • Highlight and report fraud, abuse, and anti-selection    
  • Apply terms and conditions of Bupa declaration policy in SMEs products
  • Following CCHI policy terms and conditions
  • 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
  • Play active part in managing the Manual Request on Admin list within agreed KPIs


  • Must be knowledgeable in MS Office package.
  • Computer skills at advance level is must.
  • Ability to conduct business in English language


Bachelor's degree in Nursing

Job Details

Job Location Jeddah , Saudi Arabia
Job Role Medical, Healthcare, and Nursing

Preferred Candidate

Career Level / Band Mid Career
Years of Experience Min: 1
Residence Location Saudi Arabia
Minimum Degree Bachelor's degree

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