Operational Transformation Lead: Healthcare Pre-Auth & CXE

Bupa Arabia for Cooperative Insurance Company; Riyadh; On-site; SAR 180,000 - 300,000; Full time

Job summary

Bupa Arabia for Cooperative Insurance Company seeks an experienced service management professional to oversee the Bupa Pro project execution, ensuring medical services align with defined protocols, policies, and stakeholder agreements in Riyadh.

The role emphasizes patient safety, cost control, and CXE excellence, with responsibilities spanning process improvement, provider relationship management, and compliance with SAMA/CHI regulations.

Qualifications

• Experience in managing large healthcare programs or projects.
• Ability to interpret medical policies and ensure adherence across teams.
• Strong stakeholder management and governance capabilities.

Responsibilities

• Manage Bupa Pro projects, monitor medical services, and coordinate with providers.
• Ensure cases follow Bupa protocols and policy, preventing abuse and fraud.
• Ensure medical adjudication complies with SAMA/CHI regulations.
• Lead process improvements and communications with hospitals and stakeholders.

Skills

Project management

Healthcare operations

Policy compliance

Job description

Bupa Arabia for Cooperative Insurance Company seeks an experienced service management professional to oversee the Bupa Pro project execution, ensuring medical services align with defined protocols, policies, and stakeholder agreements in Riyadh.

The role emphasizes patient safety, cost control, and CXE excellence, with responsibilities spanning process improvement, provider relationship management, and compliance with SAMA/CHI regulations.