Manager - Pre Authorization (Pipeline)

Role overview

This position is responsible for keeping medical expenditure under control for both inpatient and outpatient services by making sure pre-authorization decisions comply with SAMA and CCHI regulations, recognized medical standards, and Bupa Arabia’s values. The role must also protect member health and safety while maintaining strong service quality.

Medical cost and service management

• Assess inpatient and outpatient cases based on standard medical practice and in line with Bupa Arabia’s policies and procedures.
• Make sure approvals and rejections follow the best medical standards as well as contract terms and conditions, helping reduce misuse, fraud, and unnecessary treatment.

High-quality medical decision making and patient safety

• Maintain a high standard of decision quality with zero QDI A or B findings.
• Ensure medical decisions remain consistent and are applied according to clinical and practice guidelines approved by the organization.
• Deliver a strong customer experience aligned with Bupa Arabia’s values and overall business direction.

Efficiency management

• Meet daily productivity and turnaround expectations, including response speed targets.
• Use clinical judgment accurately and appropriately in all reviews and decisions.

Policy and regulatory compliance

• Escalate all high-value claims according to the agreed procedure.
• Identify and report fraud, abuse, and anti-selection cases.
• Apply the terms and conditions of Bupa Arabia’s declaration policy for SME products.
• Follow the terms and conditions set by CCHI policy.

Capability building and teamwork

• Continuously strengthen knowledge and experience to handle changing challenges.
• Support colleagues by sharing professional guidance and assistance.
• Offer constructive feedback and contribute to problem solving within the team.

Additional information

This role is based in Jiddah, Makkah, Saudi Arabia and is a full-time onsite position.

Education

Medicine and Surgery.

Experience and licensing

A valid Saudi Commission license is required. The ideal background includes clinical practice in general practice, emergency medicine, or family medicine. Insurance experience is preferred. A minimum of 3 years of clinical experience is required, excluding the internship year.