Manager - Healthcare Services

Bupa Arabia; Jeddah; On-site; SAR 120,000 - 240,000; Full time

Job summary

Bupa Arabia is seeking an Escalation & Recovery Case Manager in Jeddah to resolve non-approved pre-authorization escalations and restore member confidence through coordinated clinical reviews. You will work with Medical, Operations and Customer Care to clear cases and prevent backlog, while driving service recovery and continuous improvement.

You will analyze escalations and complaints to identify root causes, communicate outcomes to members clearly, and implement corrective actions with

Qualifications

• Experience with healthcare insurance operations and pre-authorization processes.
• Ability to interpret medical policies and benefits.
• Experience in case management and service recovery.
• Strong customer experience and complaint handling.
• Ability to perform healthcare analytics and reporting.
• Proficiency in quality assurance and root cause analysis.
• Experience in process improvement and operational excellence.
• Ability to interpret data visuals and dashboards.
• Strong risk assessment and escalation management.
• Excellent communication and stakeholder negotiation.

Responsibilities

• 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 backlog.
• 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.
• 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

Case management

Healthcare operations

Policy interpretation

Customer care

Analytics

Data visualization

Quality assurance

Process improvement

Communication

Stakeholder management

Escalation management

Education

Medicine and Surgery

Job description

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