محمد فارس

Bupa Arabia is one of the leading Saudi Private Medical Insurance companies. My current position’s main role is to lead a team of 5 physicians in delivering Bupa’s Chronic Disease Management and Wellness objectives. Responsibilities of the team include:

Liaise with medical and non-medical staff at healthcare providers and hospitals to ensure quality healthcare services to our customers
Conduct Chronic Disease Management, Medication Refill, Home Based Labs, Natal and Child Care Coaching through phone
Maintain and update a daily database and tracker of all issues raised and members touched
Answer medical queries from customers and as well as other departments internally within Bupa
Maintain and update a database for treating doctors and hospitals to monitor service delivery and customer experience based on a clearly defined matrix and service level
Ensure health outcomes and compliance of customers to medications and build relations with them
Support the delivery of healthcare projects by conducting follow up calls and coaching of our customers for all healthcare projects and initiatives launched
Manage international cases of our customers through collection of medical records, clinical summary and medical report writing and liaising with international parties for International Second Medical Opinion.
I also manage and constantly review each individual’s performance as set by their daily targets and KPI such as number of customers called, call quality, resolution of queries…etc.

• Implementing the wellness and chronic disease management streams of Bupa Arabia’s healthcare leadership agenda
• Monitoring implementation of generated guidelines ensuring efficiency of adjudication and proper medical cost containment
• Conducting offsite and onsite orientation seminars for different clients in alignment with the marketing agenda.
• Maintaining Bupa Arabia medical web interface
• Analyzing and monitoring the outcome of care across different providers as well as the outcome of different intervention
• Handling calls on Doctor on Phone received from Bupa Arabia members
• Comprehensive data mining to monitor and control the medical cost through international benchmarking as well as the different parameters of utilization
• Benchmarking Clinical Services provided to Bupa members to compare the clinical outcome and cost impact to ensure Best Medical Cost Management
• Developing and delivering Training for Best Medical Practices for Clinical Staff
• Governing all health related promotional and educational materials provided by Bupa to its members in alignment with the Group Health Standards, Market Values and Health Credentials.

• Responsible for medical adjudication and review of requests for medical services to our members from our affiliated healthcare providers.
• Responding to queries and complaints from our members regarding their medical coverage and benefits.
• Communicating with hospitals and treating doctors regarding our clients’ coverage, benefits and treatment options
• Reviewing medical costs and claims history of members upon renewals or health plan upgrades

Gained my first insight into the operations of a large national Health Maintenance Organization. I was the primary point of contact for any of our members seeking medical care. I was responsible for monitoring members’ admissions and hospitalization as well as specialist referrals.

Attended ward rounds, outpatient clinics and operating theatres regularly. I also attended teaching sessions weekly and presentations made by the other junior doctors in the department. Were an active participant in Clinical Audit Meetings which gave me a greater awareness of the importance of clinical governance and its role in insuring the delivery of a higher standard of healthcare to our patients through peer review and analyzing current practices.

Working as a General Practitioner in Egypt Air hospital in Cairo as part of the Egyptian Ministry of Health obligatory post graduate social service for all medical graduates.
Saw and managed common medical conditions such as Diabetes follow up, flu and common cold, rheumatoid arthritis, gastroenteritis and back pain.

Pre-Registration House Officer at the Ain Shams University Hospital, Cairo. Spent 2-month rotations in each of Medicine, Surgery, Pediatrics and Obstetrics & Gynecology. Also attended cardiothoracic surgery and Chest medicine rotations along with ER shifts.