Healthcare Services

Bupa Arabia for Cooperative Insurance Company; Jeddah; On-site; SAR 180,000 - 240,000; Full time

Job summary

Bupa Arabia for Cooperative Insurance Company is seeking a dedicated professional to manage end-to-end escalations of non-approved pre-authorization cases. The role focuses on restoring member confidence through clear communication and coordinated clinical review, while tracking escalations to reduce backlog.

The position also covers member recovery, service excellence, and continuous improvement by identifying root causes and coordinating corrective actions with cross-functional teams.

Qualifications

• No specific required skills listed in the posting.

Responsibilities

• Resolve internal escalations of non-approved pre-authorization cases.
• Coordinate clinical review of escalated cases with Medical, Operations and Customer Care teams.
• Track open escalations to manage the case backlog.
• Conduct recovery reviews for predefined eligible cases and contact members to address concerns.
• Communicate case outcomes clearly to members and follow up after adverse service experiences to restore confidence.
• Analyse escalations, complaints and rework drivers to identify root causes and opportunities for process improvement.
• Recommend corrective and preventive actions and coordinate with cross-functional stakeholders to implement them.

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.