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Services Manager Pre-Auth

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Bupa

Aug 28

  • Job
    Full-time
    Senior Level
  • Healthcare
  • Dubai
  • Quick Apply

AI generated summary

  • You must have a medical degree, 5-7 years UAE experience in PreAuth or Claims, bilingual in English and Arabic, strong Excel skills, and ability to work in diverse teams.
  • You will oversee team performance, ensure quality medical decisions, manage training, report on outputs, and address inconsistencies, while maintaining compliance and fostering a motivating environment.

Requirements

  • University Degree (MBBS, MBBCH), qualified Medical Doctor
  • Must have at least 5-7 years within Medical Insurer or TPA experience in the UAE as a PreAuth or Claims Manager
  • UAE Experience is a must
  • Ability to communicate clearly read and write effectively, in English and Arabic
  • Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations
  • Advanced knowledge of Microsoft Word, Excel and PowerPoint
  • Ability to effectively work in a multi-gender, multi-national work team; whilst displaying sensitivity towards opposite gender, cultural and ethnic differences
  • The job holder will consistently be required to report, document and problem solve provider's Requests
  • Ability to travel, in accordance to operational requirements
  • Experience in maintaining data
  • Computer skills & fast typing speed

Responsibilities

  • Monitor the overall performance of team and submit a weekly report to the pre-authorization medical manager regarding the weakness points with the recommended coaching and assessing the high- and low-quality decision takers to recognize the former and improve the latter.
  • Ensure the quality of team members' medical decisions to be up to the standards and in line with BUPA policy and guideline.
  • Execute a daily review for sles of team members' medical decisions to internally monitor and assess the quality of his team's medical decisions.
  • Ensure the commitment of team members for utilizing BUPA signed off guidelines as the method of thinking in making the medical decisions. Troubleshoot inconsistencies in decisions & processes to ensure high quality of deliverables.
  • Executing a daily edit check for more estimated cost accuracy within team members' episodes.
  • Manage the benefit spend by the business in respect of his team members ensuring that decisions are within the context of defined Policy, accepted guidelines, agreed treatment paths and pre-authorised financial and length of stay limits and in accordance with contract and policy.
  • Develop and manage Team, ensuring regular feedback, appropriate training and continually improving his team and individual performance against stated KPI's, with clear communication on business and performance issues with his team members.
  • Develop adherence to regulatory & compliance requirements for pre-authorisation adjudication and turn-round within his Team.
  • Jointly accountable with other pre-authorization teams for delivering targeted levels of Customer satisfaction.
  • Creates and maintains a working environment which motivates his team and ensures the retention of the best performers.
  • Ensure decisions consistency within his Team.
  • Make sure that reporting staff of team are achieving the quantity and quality required by management.
  • Set for his team the appropriate schedule best serving the business interest, compatible with the different reasons of decreased manpower (leaves, vacations, training, etc.), and considering the optimum conditions fitting his team members in order not to negatively influence their productivity.
  • Have a constant supervision on attendance, sick leaves, and productivity at work.
  • Produce daily informative reports & presentations about individual and team output.
  • Work as a referral point by providing clinical output for complex medical cases. Create tip sheets & also create regular clinical training programs for relevant stakeholders.
  • Identify points of weaknesses, individually and collectively, report them and works with the manager on rectifying them.
  • Provide second check on fraud and Anti selection cases, making sure that such cases are dealt with according to guidelines.
  • Make sure that his team maintains an appropriate rejection rate, which is an essential part of the team contribution to the profit of the company.
  • Develop and manage process & content changes in coordination with the Project delivery teams.
  • May participate and/or serve on unit's committees, workshops, and task forces.
  • Maintain full cooperation with internal & external stakeholders by providing them with all the support needed to solve complaints arising part of daily activities.

FAQs

What is the job title for the position being offered?

The job title is Services Manager Pre-Auth.

Where is the job location for this position?

The job is located in Dubai, UAE.

Is this position full-time or part-time?

This position is full-time.

What are the main responsibilities of the Services Manager Pre-Auth?

The main responsibilities include monitoring team performance, ensuring quality medical decisions, managing benefit spend, developing team members, and maintaining compliance with regulatory requirements.

What qualifications are required for this role?

A University Degree as a qualified Medical Doctor (MBBS, MBBCH) and at least 5-7 years of experience in the UAE within Medical Insurer or TPA as a PreAuth or Claims Manager are required.

Is UAE experience mandatory for this role?

Yes, UAE experience is a must.

What languages are required for this position?

The ability to communicate clearly in English and Arabic, both in writing and speaking, is required.

What skills are important for the Services Manager Pre-Auth position?

Important skills include advanced knowledge of Microsoft Word, Excel, and PowerPoint, as well as the ability to apply mathematical concepts and effectively work in a multi-gender, multi-national team.

Does the position require any travel?

Yes, the ability to travel in accordance with operational requirements is required for this role.

What is the role of the Services Manager in terms of team management?

The Services Manager is responsible for developing and managing the team, providing regular feedback, training, and improving individual and team performance against stated KPIs.

Will the Services Manager have a role in handling complex medical cases?

Yes, the Services Manager will work as a referral point for complex medical cases and create training programs for relevant stakeholders.

Are there opportunities for professional development in this role?

Yes, the Services Manager is expected to develop training programs and conduct regular clinical training for team members and relevant stakeholders.

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Bupa

Our purpose is helping people live longer, healthier, happier lives and making a better world.

Science & Healthcare
Industry
10,001+
Employees
1947
Founded Year

Mission & Purpose

upa's purpose is helping people live longer, healthier, happier lives and making a better world. We are an international healthcare company serving over 38 million customers worldwide. With no shareholders, we reinvest profits into providing more and better healthcare for the benefit of current and future customers. We directly employ around 85,000 people, principally in the UK, Australia, Spain, Chile, Poland, New Zealand, Hong Kong SAR, Türkiye, Brazil, Mexico, the US, Middle East and Ireland. We also have associate businesses in Saudi Arabia and India.