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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.
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
Skills
- 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.
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.
