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The incumbent is responsible for leading the overall Healthcare function, encompassing claims assessment and medical provider management, ensuring alignment with company strategy, operational standards, and regulatory requirements. This includes overseeing service delivery, quality assurance, risk management, and vendor governance to support sustainable healthcare business growth.
The role drives strategic collaboration with internal stakeholders, as well as external partners, to optimize cost management, mitigate risks, identify emerging fraud and abuse trends, and enhance customer experience. The incumbent is also accountable for driving continuous improvement initiatives, strengthening operational efficiency, and ensuring consistent service excellence across the Healthcare ecosystem.
Job Description
Lead and oversee end-to-end Healthcare operations, including claims assessment and medical provider network management, ensuring alignment with business objectives, policies, and regulatory requirements.
Define and drive healthcare strategies covering service delivery, cost containment, risk management, and customer experience improvement.
Provide governance and oversight for claims adjudication and provider management processes, ensuring quality, SLA adherence, and compliance with audit and risk frameworks.
Drive cross-functional collaboration with NBUW, PD, Marketing, Agency, and other stakeholders to manage risk exposures, improve product design, and enhance customer value proposition.
Lead engagement with external stakeholders, including medical providers and TPA, to ensure service quality, effective partnership, and alignment with company standards.
Oversee identification and management of fraud, waste, and abuse (FWA) trends, leveraging data insights to recommend strategic actions and preventive measures.
Drive healthcare-related projects and initiatives, including process transformation, system enhancement, and service innovation, ensuring effective implementation and measurable outcomes.
Oversee provider network strategy, including empaneling, contract management, performance monitoring, and service quality governance.
Lead organization-wide initiatives to enhance customer experience across the healthcare journey, including claims servicing and provider interactions.
Manage and develop leadership capabilities within the team, ensuring effective performance management, succession planning, and capability building.
Other assignment by the leadership team
Job Accountability
The incumbent leads the overall Healthcare function, ensuring integrated claims assessment and provider management to deliver high-quality, compliant, and efficient services.
The role drives cross-functional collaboration and stakeholder engagement to manage risks, monitor abuse trends, optimize costs, and enhance customer experience, while ensuring effective governance, performance, and continuous improvement across Healthcare operations.
Job Requirements / Yêu cầu
Qualification: Degree in Biomedical Science, Allied Health, Economics, Business Administrative, Business Management, and etc.
Experience
Preferably experience in healthcare and/or claims, i.e. customer Service, HealthCare claims department or Hospital environment will be required.
Working at an insurance company or banking at managerial level for at least 5 years.
Knowledge, Skills & Attributes
Insurance/Legal/Health management and project management, Possess knowledge on Life Insurance claims processing.
Computer literate and familiar with MS Excel, MS Word & MS PowerPoint.. Self-assured and results oriented
Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organisation irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part-time / fixed-term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third-party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.