Bupa Arabia
Bupa Arabia is looking for an experienced Manager – Medical Pre Authorisation in Riyadh, Saudi Arabia.
The role makes clinically appropriate, evidence-based pre-authorisation decisions. It covers utilisation management, regulatory compliance and provider engagement, while protecting patient outcomes, improving customer experience and using healthcare resources carefully.
Key Responsibilities:
Apply evidence-based medicine, clinical guidelines and policy terms when reviewing pre-authorisation requests.
Support appropriate use of healthcare services and help avoid unnecessary cost.
Contribute to cost-control work through sound medical adjudication and utilisation management.
Keep medical decisions clinically sound and consistent.
Monitor decision quality and adherence to medical protocols.
Build provider satisfaction through clear communication and partnership.
Escalate high-value, complex or critical cases when needed.
Take part in complaint handling and support business continuity.
Maintain effective communication with internal and external stakeholders.
Report operational risks and critical incidents promptly.
Follow Bupa policies, medical protocols and regulatory requirements, including CHI rules.
Identify and report suspected fraud, waste, abuse and anti-selection.
Support audit readiness and compliance monitoring.
Qualifications & Requirements:
Bachelor’s degree in Medicine or equivalent. Postgraduate medical qualification preferred.
Minimum 3 years of medical experience.
Clinical background as a General Practitioner, in Emergency or in Family Medicine.
Medical insurance practice experience.
English language and basic computer skills.
Salary & Benefits:
Standard corporate package as per company policy
To apply for this job please visit careers.bupa.com.sa.