Services Manager Pre-auth

2 months ago

Dubai, United Arab Emirates Bupa Global Full time

Services Manager Pre-Auth

**Job Description**:
**R1161388 Services Manager Pre-Auth**

**Dubai, UAE**

**Full-time**

Here you'll be welcomed. We chion diversity and we understand the importance of our people representing the communities and customers we serve. You'll find an inclusive environment where you can be yourself and where everyone is driven by the same purpose - helping people live longer, healthier, happier lives and making a better world.

Bupa Global is the international health insurance division of Bupa. We provide customers who want premium international coverage with products and services to access the healthcare they need anytime, around the world, whether at home or when studying, living, travelling or working abroad.

Bupa Global has offices around the world including London and Brighton (UK), Dublin (Europe), Miami (USA), Dubai (UAE, in partnership with OIC), Egypt and Hong Kong (China) as well as regional offices in mainland China, Singapore, the Dominican Republic, Bolivia, Panama, Guatemala and Ecuador.

**How you'll help us make health happen**:

- 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

**Key Skills / Qualifications needed for this role**:

- 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.
- 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

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