Sr. Officer - Medical Pre Authorization

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.

The role responsible for the following: 

• Medial cost & Service Management: 
• 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 achieving of daily targets in terms of productivity & speed of response
• Ensure proper interpretation and usage of clinical skills
• Ensure compliance to policy and Regulation • Report all high Value claims 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
• Support & contribute in capability building, constantly upgrade his knowledge and experience in order to meet challenges

• Bachelor's degree in any relevant majors pharmaceutical, Nursing majors.
• Fresh graduate up to 3 years experience.
• Ability to conduct business in English language.
• Ability to work under pressure.
• Strong communication skills. 

Nurs or Medical Degree