Manager - Medical Pre Authorisation

Bupa Arabia; Jeddah; On-site; SAR 180,000 - 240,000; Full time

Job summary

Bupa Arabia in Jeddah is seeking a Medical Cost & Service Management professional to ensure clinically appropriate preauthorization decisions, apply evidence‑based guidelines, and engage providers to optimize patient outcomes and resource use.

The role emphasizes compliance, governance, risk management, and clear communication with internal and external stakeholders, including complaint handling and incident reporting.

Qualifications

• Minimum 3 years of Experience – Medical
• Clinical experience as General Practitioner / Emergency / Family Medicine
• Medical insurance practice
• Language (English) and basic computer skills
• Bachelor’s in medicine or equivalent
• Postgraduate in Medicine and surgery
• 2 years’ experience at least in medical field ( Hospital practicing ) or at insurance field

Responsibilities

• Ensure clinically appropriate, evidence-based preauthorization decisions through utilization management, regulatory compliance, and provider engagement.
• Support cost-containment initiatives through effective medical adjudication and utilization management.
• Monitor decision quality and adherence to medical protocols.
• Promote provider satisfaction through effective communication and partnership management.
• Manage and escalate high-value, complex, or critical cases when required.
• Report operational risks and critical incidents in a timely manner.

Skills

Clinical experience

Medical insurance practice

Language (English)

Basic computer skills

Education

Medicine and Surgery degree

Job description

Job Description

Ensure clinically appropriate, evidence-based preauthorization decisions through effective utilization management, regulatory compliance, and provider engagement, while safeguarding patient outcomes, enhancing customer experience, and optimizing healthcare resource utilization.

Medical Cost & Service Management

• Apply evidence-based medicine, clinical guidelines, and policy terms during preauthorization review.
• Ensure appropriate utilization of healthcare services while preventing unnecessary costs.
• Support cost-containment initiatives through effective medical adjudication and utilization management.

Quality Medical Decision & Patient Safety

• Ensure clinically sound and consistent medical decisions.
• Monitor decision quality and adherence to medical protocols.
• Promote provider satisfaction through effective communication and partnership management.

Business Support & Stakeholder Management

• Manage and **escalate** high-value, complex, or critical cases when required.
• Participate in complaint resolution and support business continuity efforts.
• Maintain effective communication with internal and external stakeholders.
• Report operational risks and critical incidents in a timely manner.

Compliance, Governance & Risk Management

• Ensure adherence to Bupa policies, medical protocols, and regulatory requirements.
• Comply with CHI regulations and governance standards.
• Identify, **escalate**, and report suspected fraud, waste, abuse, and anti-selection activities.
• Support audit readiness and compliance monitoring activities.

Skills

• Minimum 3 years of Experience – Medical
• Clinical experience as General Practitioner / Emergancy / Family Medicine
• Medical insurance practice
• Language (English) and basic computer skills
• Bachelor’s in medicine or equivalent
• Postgraduate in Medicine and surgery
• 2 years’ experience at least in medical field ( Hospital practicing ) or at insurance field

Education

Medicine and Surgery