Medical Excellence Pre‑Authorization Manager

About the role

The Manager – Medical Excellence Pre‑Authorization is responsible for ensuring that all medical service decisions, contracts and provider agreements are aligned with Bupa Arabia’s policies and regulatory requirements. The role focuses on delivering high‑quality pre‑authorization processes, improving customer experience, and managing medical cost and service performance across the provider network.

Key responsibilities

• Monitor pre‑authorization standards and ensure provider compliance with operational instructions.
• Guide insurance and provider teams to achieve optimal customer experience without increasing costs.
• Make quality medical decisions that safeguard patient safety and adhere to Bupa medical protocols.
• Track and analyse customer satisfaction metrics (CSAT, TNPS) within provider organizations.
• Maintain clear communication with providers and enforce Bupa policy terms.
• Identify and report fraud, abuse and anti‑selection activities.
• Oversee efficiency of adjudication requests and case management for the PA team.
• Achieve daily productivity targets and apply clinical skills with operational excellence.
• Lead process‑improvement initiatives and ensure adherence to operational instructions.
• Build capability and manage people through goal setting, coaching and performance feedback.
• Facilitate collaboration between internal and external stakeholders and support business communication.
• Participate in complaint management, crisis reporting and escalation of high‑value or critical cases.

Required profile

• Minimum of 1 month experience in medical services or a related field.
• Clinical background preferred (e.g., General Practitioner, Emergency Medicine, Family Medicine).
• Ability to work effectively with insurance, provider and internal teams.

Required skills