Job ref no.: 96627 (CT3125868-01#9852)

Medical Operations Specialist

Swiss Re

 

About the Role

This role works closely with cross-functional teams including Medical Doctors, Underwriters, Client Managers, Pricing Actuaries, Product Solutions, Data Analytics, Technical Accounting and other Asia markets under Asia Life & Health line of business.

Clients:

  • To provide healthcare consulting support to clients related to areas including but not limited to medical claims management, network consulting and contracting, medical management programs, pharmaceutical management, healthcare insurance solutions, innovative product development, insurtech solutions, provider profiling, TPA selection and operations.
  • To support the Business Unit in new business tenders and in management of renewals of business, and in promoting team profile, value proposition and expertise in HKSAR.
  • To create and maintain a positive relationship with senior management at clients (COOs, Product Development, Claims managers) to help SR manage our reinsured portfolio and to help us win new business.
  • To position SR as thought leader and influencer for claims management and medical operations in HKSAR.

People:

  • To work closely with Client Markets to ensure best in class service to our Clients;
  • To collaborate with cross-functional teams (medical pricing, underwriting, solutions, business management) for portfolio management, data analysis and interpretation with appropriate feedback for future product development, risk management strategies and pricing as well as suggest appropriate interventions to improve the portfolio's overall experience.
  • To effectively bring and work on best practices which may be used in medical operations teams in other countries.
  • To keep abreast of the impact of any regulatory or market practice changes that may impact the business or the portfolio or product development and present the same to internal teams.

Operational Excellence:

  • To effectively manage SR claim liability through identifying and implementing appropriate client and claims management / risk management strategies within the terms and conditions of the policy and pricing assumptions.
  • To assess and process claims related to medical products in accordance with operating procedures as required.
  • To develop, articulate, and to maintain Swiss Re best practice and guidelines for product risk appetite, portfolio / provider / TPA / and operational infrastructure.
  • To ensure the data integrity of systems/databases for all claims adjudicated or assessed.
  • To prepare and present reports on operations, data analytics, best practices, portfolio benchmarking assessment etc. both internally and to clients on a pre-agreed frequency.

About the Team

To support Asia L&H Medical Operations team with focus on Hong Kong market by providing full range of Medical Operations related technical expertise and consulting services to deliver medical products' value chain and operation strategy throughout Life & Health business of Swiss Re in the Hong Kong Special Administrative Region (HKSAR) of the People’s Republic of China (PRC).

About You

  • Degree holder in medicine, healthcare, insurance, risk management or other professional qualifications;
  • Excellent technical knowledge and experiences in medical insurance operations including claims adjudication, approvals and management practices, medical insurance product design, benefit features and definitions, network management and TPA services contracting. Clinical background a plus but not mandatory;
  • At least 5 years of work experiences with direct insurers, reinsurance companies, third party administrator (TPA) companies and/or healthcare groups in Hong Kong. Overseas experience a plus;
  • Proficient in English and Cantonese. Good command of Mandarin a plus.
  • Highly self-motivated, team player, customer-oriented, mature, able to work independently with excellent interpersonal, communication and influencing skills;
  • Analytical, problem solving, decision making, reporting, presentation, training and data analytical skills are essential. Auditing experience a plus.
  • Multi-task, attention to detail, strong risk mindset, work under tight timelines.

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More job information
Job ref no. 96627 (CT3125868-01#9852)
Salary
Job Function
Industry
Employment Term
  • Permanent
  • Full-time
Experience
  • 5 years - 10 years
Career Level
  • Non-management level
Education
  • Degree