Job Detail

Sr. Officer

Posted on Aug 11, 2020
Location: Jeddah, Saudi Arabia
Industry: Consulting / Advisory Services
Job Type: Others
Education: Bachelors

Job Description

Ensure medical cost control through managing benefit spend for Out Patient services only, making sure that decisions are within defined SAMA & CCHI regulations, accepted guidelines and high quality common medical standards safe guarding the member's health & safety and in line with Bupa Values.

The role responsible for the following:



- Medial cost & Service Management:

- Ensure the decisions are according to the best medical standards and agreements' terms & conditions in order to prevent abuse, fraud and overtreatment

- Ensure member safety through working with High Quality of decision making with Zero QDI (Quality Demerit Index) A or B

- Ensure the medical decisions are consistent and proper implementation of the clinical and practice guidelines signed off by the organization

- Ensure achieving of daily targets in terms of productivity & speed of response

- Ensure proper interpretation and usage of clinical skills

- Ensure compliance to policy and Regulation • Report all high Value claims as per agreed process with in Out Patient services

- Highlight and report fraud, abuse, and anti-selection Apply terms and conditions of Bupa declaration policy in SMEs products Following CCHI policy terms and conditions

- Support & contribute in capability building, constantly upgrade his knowledge and experience in order to meet challenges





NOTICE: Esteemed Candidate, You bear complete responsibility for engaging with the employer througout the hiring process. GulfJobs.com disclaims any responsibility regarding your recruitment. A legitimate employer will never request payment for hiring!