Tamheer- Operations Support; MCU; TPA

Overview

Enhancing the customer experience (CX) for clients concerned with non-approved cases and referral management by applying PA decision review, case management processes, direct contact with clients, and coordination with internal and external stakeholders within defined time frames and TOB restrictions. Identify and tackle root causes that lead to non-approval to improve the volume and quality of non-approval decisions.

• Review cases appearing on the Aramco MCU list, whether diverted from the PA work list or created by other stakeholders, to ensure the quality of the decision and the application of TOB guidance by PA users or automated systems.
• Review referral cases to proceed with allocating the requested services and issuing the needed referral documents when requested.
• Demonstrate good judgment, adaptive business intuition, and strong teamwork to collaborate effectively with team members.

• Review cases appearing on the Aramco MCU list, diverted from the PA work list or created by other stakeholders, to ensure the quality of the decision and the application of TOB guidance by PA users or automated systems.
• Review referral cases to proceed with allocating the requested services and issuing the needed referral documents when requested.
• Demonstrate good judgment, adaptive business intuition, and strong teamwork to work well with team members.

• Direct interaction with clients by phone to explain decisions, processes, and obtain necessary data (for outpatient cases only), to be highlighted to managers/senior managers in the recovery team.
• Respond to internal stakeholders' queries via CMT/Emails.
• Outbound calls for member experience assessment.
• Communicate with patients in NPR cases when needed.
• Operate within legal and operational requirements defining interaction guidelines with clients as imposed by Bupa, regulators, or client institutions.

• Coordinate with data analysts and use simple problem-solving and root cause analysis tools to monitor deviations in the breakdown, volume, and origin of cases managed on the recovery list.
• Record completed transactions in platforms/Excel sheets on a daily basis.

• Strong logical, analytic, presentation, assessment, and interpretation skills.
• Advanced communication and negotiation skills.
• Basic to intermediate knowledge of Microsoft Office.
• Able to multitask and work well under stress.
• Strong troubleshooting, problem-solving, analytical skills, and excellent follow-up.
• Ability to effectively prioritize and execute tasks in a high-pressure environment.
• A medical science degree (pharmacology, clinical laboratories, nursing, physiotherapy, etc.).
• Any degree or training in Excel, Data Management and Dashboards, Business Writing, or Client Management may be considered.