Key Facts

Remote From:

Full time

Senior (5-10 years)

, English

Bachelor's degree in business, finance, insurance, health administration, or related field
2-3 years of claims management experience, preferably in life/health insurance or a digital health platform in Asia
Experience with claims operating systems, workflow automation, data analytics tools, and proficiency in Microsoft Office and claims management software
Knowledge of insurance regulations and digital health compliance requirements in Asia, plus strong analytical, problem-solving and stakeholder engagement skills

Manage and oversee a portfolio of complex claims with adherence to SLAs, accuracy, and regulatory standards
Provide guidance, training, and SME support to claims and customer service teams; resolve escalations and develop best practices
Investigate, adjudicate, and determine eligibility and liability using documentation, data analytics, and digital health records; ensure compliance with policies and digital health laws
Monitor claims performance with KPIs/dashboards; drive data-driven process improvements and cross-functional system enhancements; maintain databases and regulatory reports

Job description

Operations / Senior Operations Executive (Claims) Health Tech Platform

Key Responsibilities

Manage and oversee a portfolio of complex claims, ensuring prompt, accurate, and transparent processing in accordance with internal SLAs and regulatory standards.
Provide guidance, training, and support to claims and customer service team members; act as a Subject Matter Expert (SME) to resolve escalated cases and develop best practices.
Investigate, assess, and adjudicate claims, including review of documentation, data analytics, and digital health records, to determine eligibility, coverage, and liability.
Ensure strict compliance with company policies, industry regulations, and evolving digital health legislation in local and international markets.
Monitor, analyze, and report on claims performance using KPIs and dashboards; drive data-driven process improvement projects aiming for higher efficiency, automation, accuracy, and customer satisfaction.
Collaborate cross-functionally on system enhancements as well as solving customer enquiries.
Maintain accurate up-to-date claims databases and generate regular and ad hoc management reports for internal and regulatory review.
Proactively identify operational risks and recommend process or technology improvements.
Process Business as Usual (BAU) operational processes as well and any ad hoc tasks to improve company efficiency.

Qualifications

Bachelors degree in business, finance, insurance, health administration, or a related field.
Minimum 2-3 years experience in claims management, ideally in life/health insurance or a digital health platform in Asia.
Preferred Experience with claims operating systems, workflow automation, and data analytics tools; proficiency in Microsoft Office and relevant claims management software.
Sound knowledge of insurance regulations, industry standards, and digital health compliance requirements in Asia.
Strong analytical, investigative, and problem-solving skills with a keen eye for process optimization.
Excellent communication, negotiation, and interpersonal skills; able to engage diverse stakeholders and influence outcomes.
Self-driven, results-oriented, and comfortable working in fast-growing, dynamic, and digital-first environments.
Strong language capabilities especially in Cantonese, Mandarin as well as English