Tamheer -Elite Program

Bupa Arabia; Riyadh; On-site; SAR 120,000 - 180,000; Full time

Job summary

Bupa Arabia in Riyadh seeks a skilled service coordinator to manage members’ experience across operational functions, ensuring timely delivery of services end-to-end at every touchpoint.

You will proactively facilitate Tebtom and core healthcare services, act as main contact for pre-authorization and reimbursements, collaborate with cross-functional teams, and drive KPI reporting and PCC dashboard development.

Qualifications

• Proficient in reimbursement claims, pre-authorization and related approvals.
• Knowledge of HCO/Tebtom, international and POC services is preferred.
• Strong customer-focused service orientation for Bupa members.

Responsibilities

• Manage members’ end-to-end experience across operational functions to ensure timely service delivery.
• Proactively facilitate Tebtom and core healthcare services tailored to members’ medical needs.
• Serve as main contact for information on Bupa services (pre-authorization, reimbursements, Tebtom, hospital delegate services).
• Collaborate with cross-functional leaders to customize healthcare services for targeted populations.
• Collect post-service feedback to assess service quality.
• Provide information on medical services to members and families.
• Direct members to doctors or providers to ensure high-quality care.
• Refer medical needs to appropriate departments as required.
• Support customer segmentation and segment-specific service delivery.
• Report KPI updates with analytics teams; prepare PCC dashboards and progress updates.

Skills

Reimbursement claims handling

Pre-authorization

Commercial approval requests

Membership and benefits coverage

HCO/Tebtom knowledge

International and POC services

Customer-focused service

Verbal and written communication

Inbound/outbound calls flexibility

Healthcare background

Job description

Job Description

• Manage members’ experience with the relevant operational functions to ensure that services are delivered to the members end to end in every touch point of their journey on a timely manner.
• Proactively propose and facilitate Tebtom and all other core healthcare services to the members to ensure that they will receive an appropriate care customized to their current medical needs.
• Serve as the main point of contact in providing timely information to the members about Bupa services i.e. pre-authorization, reimbursement claim, Tebtom, hospital delegate services, etc.
• Collaborate with cross functional service leaders to customize healthcare services according to the healthcare needs of the targeted population.
• Constantly striving in providing excellent service by collecting post-service feedbacks through online questionnaire to assess the quality of service provided to the members.
• Provide accurate and useful information to the members and their families on medical information or specific Bupa services.
• As necessary direct the members to the recommended doctors and/or alternative providers to ensure that they will be receiving a high level of quality in medical services.
• Assess the medical need of the members and refer her to appropriate department i.e. HCS for corresponding medical coaching intervention as required.
• Support the understanding of customer and consumer segmentation to offer breakthrough Healthcare services
• Support the implementation and segmented serving of our core healthcare services
• Report & lead consistently the reporting of KPIs updates for each service offering with data analytics team of the departments
• Lead the development and maintenance of Personal Coordinated Care (PCC) dashboard to monitor, review and report progress of KPIs against targets in a consistent manner
• Prepare, manage and conduct presentations and business updates to key leaders within the organization
• Provide monthly feedback report on the progress of PCC program as part of updates in overall Retention report
• Analyse the top recurring issues or service failures which members are facing in the critical touch point along the customer experience journey, and with all stakeholders identify solid actions to eliminate or at least reduce the problems at the minimum level
• Monitor and review the progress of Kaizen projects implementation in a timely and consistent manner using a structured action plan and tracker
• Ensure risk identification, escalation and mitigation of risks in a timely manner to identify and resolve any impact on project outcome or agreed timelines during project delivery

Job Description

• Manage members’ experience with the relevant operational functions to ensure that services are delivered to the members end to end in every touch point of their journey on a timely manner.
• Proactively propose and facilitate Tebtom and all other core healthcare services to the members to ensure that they will receive an appropriate care customized to their current medical needs.
• Serve as the main point of contact in providing timely information to the members about Bupa services i.e. pre-authorization, reimbursement claim, Tebtom, hospital delegate services, etc.
• Collaborate with cross functional service leaders to customize healthcare services according to the healthcare needs of the targeted population.
• Constantly striving in providing excellent service by collecting post-service feedbacks through online questionnaire to assess the quality of service provided to the members.
• Provide accurate and useful information to the members and their families on medical information or specific Bupa services.
• As necessary direct the members to the recommended doctors and/or alternative providers to ensure that they will be receiving a high level of quality in medical services.
• Assess the medical need of the members and refer her to appropriate department i.e. HCS for corresponding medical coaching intervention as required.
• Support the understanding of customer and consumer segmentation to offer breakthrough Healthcare services
• Support the implementation and segmented serving of our core healthcare services
• Report & lead consistently the reporting of KPIs updates for each service offering with data analytics team of the departments
• Lead the development and maintenance of Personal Coordinated Care (PCC) dashboard to monitor, review and report progress of KPIs against targets in a consistent manner
• Prepare, manage and conduct presentations and business updates to key leaders within the organization
• Provide monthly feedback report on the progress of PCC program as part of updates in overall Retention report
• Analyse the top recurring issues or service failures which members are facing in the critical touch point along the customer experience journey, and with all stakeholders identify solid actions to eliminate or at least reduce the problems at the minimum level
• Monitor and review the progress of Kaizen projects implementation in a timely and consistent manner using a structured action plan and tracker
• Ensure risk identification, escalation and mitigation of risks in a timely manner to identify and resolve any impact on project outcome or agreed timelines during project delivery

Skills

• Fully operational in handling cases on Reimbursement claims, Pre-authorization approval, commercial approval requests, Membership and benefits coverage
• Working knowledge in HCO/Tebtom, International and POC services
• Highly customer-focused and strong service orientation providing superior services to Bupa members
• Excellent verbal and written communication skills, with the ability to convey issues in a clear, concise and effective manner
• Flexible to receive inbound calls and make outbound calls from/to the members and during weekend, holidays and outside working hours
• Preferably having healthcare background