Summary
Bupa Arabia is seeking a Manager, Healthcare Services in Jeddah. The role handles internal escalations of non-approved pre-authorization cases, coordinates clinical reviews across teams, and tracks cases through resolution. It also involves contacting members, communicating outcomes, and reviewing complaints and rework to identify root causes and recommend improvements. The posting asks for a Medicine and Surgery education and experience or skills in healthcare insurance operations, case management, analytics, and service recovery.
The posting
As published on bupa.com.sa. Pulled from the employer's site and shown as they wrote it.
Job Description
To resolve internal escalations of non-approved pre-authorization cases on time and restore member confidence through clear communication and coordinated clinical review.
End-to-End Escalation & Recovery Case Management
• Handle internal escalations of non-approved pre-authorization cases.
• Coordinate clinical review of escalated cases.
• Coordinate with Medical, Operations and Customer Care to resolve cases on time.
• Track open escalations to control the case backlog.
Member Recovery & Service Excellence
• Conduct recovery reviews for predefined eligible cases.
• Contact members to understand and address their concerns.
• Communicate case outcomes to members clearly.
• Follow up after adverse service experiences to restore member confidence.
Continuous Improvement & Root Cause Analysis
• Analyse escalations, complaints and rework drivers to identify root causes.
• Identify process gaps and improvement opportunities.
• Recommend corrective and preventive actions for approval.
• Coordinate agreed actions with cross-functional stakeholders.
Skills
• Healthcare insurance operations and pre-authorization processes
• Medical policy and benefit interpretation
• Case management and service recovery methodologies
• Customer experience and complaint management
• Healthcare analytics and performance reporting
• Quality assurance and root cause analysis
• Process improvement and operational excellence
• Data visualization and dashboard interpretation
• Risk assessment and escalation management
• Communication, stakeholder management and negotiation skills
Education
Medicine and Surgery