Closed or Expired Job Posting This job posting is closed or has expired and is no longer open for applications.
Upload
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.
