Claims Operations Lead

Overview

Amplify Health Asia Pte. Limited (Amplify Health) is a leading health technology and analytics organisation, providing our customers with integrated solutions to improve outcomes for individuals and the sustainability of health systems. We aim to be a trusted custodian of Asia's largest repository of health data, unifying financial, clinical, operational and behavioural data to empower our customers with insights that highlight opportunities to deliver better value and care outcomes.

We are looking for someone who can lead and implement a comprehensive strategy for Amplify Health to drive impactful transformation of claims operations.

What You Will Do

Strategy Development and Execution

• Develop and implement a comprehensive strategy for Amplify Health to drive impactful transformation of claims operations for our clients, who are health care payors (private insurers, public payors, other payors) across the region, ensuring alignment with the client's organisational objectives.
• Identify opportunities to optimize claims processing through organizational redesign, business model and process redesign, incorporating automation, technology adoption and strategic partnerships.
• Drive initiatives to improve straight-through processing (STP) rates, reduce manual interventions, and enhance decision accuracy.

Technology And Innovation

• Collaborate with AH's product teams to design and deploy AH solutions.
• Collaborate with the client's technology/data teams to ensure deployment of technology/data solutions are aligned with operational needs and changes to optimize value in delivery.
• Work closely with technology teams to deploy AI-driven solutions for fraud detection, waste minimization, and claims adjudication.
• Oversee the integration of advanced analytics tools and predictive models to streamline claims workflows.
• Evaluate emerging technologies and partner with insurtech vendors to stay at the forefront of industry innovation.

Process Optimization

• Lead initiatives to re-engineer end-to-end claims processes, focusing on operational efficiency and cost reduction.
• Implement best practices in medical claims management, including robust quality assurance and compliance frameworks.
• Develop and monitor KPIs to track transformation success and continuously improve outcomes.

Stakeholder Engagement

• Collaborate with cross-functional teams, including underwriting, actuarial, provider management, and customer service, to ensure seamless claims operations.
• Serve as a key liaison between business stakeholders and technical teams to translate business needs into actionable solutions.
• Engage with external stakeholders, including providers and regulators, to align transformation efforts with industry standards and requirements.

Change Management

• Lead organizational change efforts to foster a culture of innovation and adaptability within the claims team.
• Provide training and support to ensure smooth adoption of new processes and technologies.
• Communicate transformation goals, progress, and outcomes to leadership and other key stakeholders.

Fraud, Waste, And Abuse Management

• Implement advanced solutions to detect, prevent, and mitigate fraud, waste, and abuse (FWA) in medical claims.
• Recommend process improvements for claims audit and tracking of value delivery.
• Collaborate with special investigation units (SIUs) and analytics teams to refine FWA detection models and processes.

Provider Risk Management

• Ideate with provider management and claims operations teams on solutions for executing and tracking hospital and doctor agreements into insurer workflows and systems.
• Document new operations and systems solutions: translate business requirements from provider teams into SOPs, system rules and new workflows where changes are required (e.g., pre-auth, IGL, FGL, claims processing).
• Map gaps by observing workflows related to provider management to identify opportunities to capture more value.

Qualifications

What you need to be successful

• Education: Bachelor's degree in engineering, Business Administration, Healthcare Management, or a related field; MBA or advanced degree preferred.
• Experience: 15+ years of experience in medical claims operations, healthcare insurance, or related fields; proven track record of leading claims transformation or process improvement initiatives; strong background in utilizing AI, automation, and analytics in claims processes.
• Technical Skills: Familiarity with claims adjudication platform design frameworks, AI-driven FWA detection tools, and analytics capabilities.
• Leadership: Exceptional leadership, strategy and change management skills.
• Communication: Strong communication and stakeholder management abilities to influence and drive cross-functional collaboration.

Preferred Skills

• Experience with SaaS-based claims solutions and digital health platforms.
• Knowledge of regulatory compliance and standards in healthcare insurance.
• Clinical background or understanding of medical terminology is a plus.

Other

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.

About AIA

For over a century, AIA has served the ever-changing needs of our customers across Asia-Pacific. Our Purpose to help millions of people live Healthier, Longer, Better Lives is at the heart of everything we do.

As pioneering innovators, we're now transforming AIA to be faster, simpler and more connected to create better solutions and impactful experiences for our customers and communities. AIA encourages and enables our people to act with clarity, courage and humanity in service of our Purpose.

Join Us

At AIA, we believe in empowering every one of our people to find their better - in the work they do, the career they build, the life they live and the difference they make. AIA is committed to building a vibrant, diverse, and inclusive workforce for all employees to thrive in. Join us if you believe in creating a better tomorrow

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