Claims Operations Lead

Amplify Health Asia Pte; Singapore; On-site; SGD 120,000 - 180,000; Full time

Job summary

Amplify Health Asia Pte is seeking an experienced leader to drive claims operations transformation for healthcare payors. This role involves developing strategies, optimizing processes through technology, and engaging with stakeholders to enhance efficiency. Ideal candidates will possess extensive experience and a strong understanding of healthcare insurance and claims management.

Qualifications

• 15+ years of experience in medical claims operations or healthcare insurance.
• Proven track record of leading claims transformation initiatives.
• Strong background in utilizing AI and analytics in claims processes.

Responsibilities

• Develop and implement strategy for claims operations transformation.
• Drive initiatives to optimize claims processing through technology and partnerships.
• Lead change management efforts to foster innovation within the claims team.

Skills

Leadership

Change management

Stakeholder management

Communication

Strategic thinking

Education

Bachelor’s degree in engineering, Business Administration, Healthcare Management, or a related field

MBA or advanced degree preferred

Tools

Claims adjudication platform design frameworks

AI-driven FWA detection tools

Analytics capabilities

Job description

Who we are

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’ve set a bold vision

The vision for Amplify Health is to be a leading digital health technology and integrated solutions business.

Our Culture and Values

At Amplify Health, we believe in fostering a culture that embodies the spirit of Courageous Entrepreneurs. We are passionate and innovative individuals who continuously strive to push boundaries and think outside the box. We understand that calculated risks are essential for driving progress, and we view failures as valuable opportunities to learn and grow.

As Outstanding People, collaboration, learning, and growth are at the core of our values. We trust and rely on each other, working together as a unified team to achieve our goals. When success comes our way, we celebrate it as a collective achievement, and we are committed to improving and excelling together.

We firmly believe in the mantra of Discuss, Decide, Do. Listening is fundamental in our decision-making process, and we act promptly, ensuring accountability in everything we do. Simplicity is the key to our efficiency, and we get things done quickly and effectively while being guided by facts and understanding.

At the heart of our pursuits lies a Lasting Impact. We prioritize the needs of our customers, and we are crystal clear about the problems we are solving for them. Progress is our north star, and while we strive for excellence, we acknowledge that perfection is a journey, and we remain focused on delivering excellent products that make a tangible difference.

If you are a passionate and innovative individual who thrives in a collaborative environment, where courage is celebrated, and customer focus is paramount, we invite you to join our team. Together, we will shape the future with our unwavering commitment to excellence and the determination to make a lasting impact in the industry.

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 in ensuring alignment with Client’s organisational objectives.
• Identify opportunities to optimize claims processing through organizational redesign, business model and process redesign, incorporating automation, technology adoption and also 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 the 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
• Tracking of value delivery
• Collaborate with special investigation units (SIUs) and analytics teams to refine FWA detection models and processes.

Provider Risk Management:

• Problem solve: ideate with the provider management and claims ops teams on the various solutions for executing and tracking the hospital and doctor agreements into insurer workflows and systems
• Document new ops and systems solutions: translate the business requirements from provider team into SOP’s, system rules and new workflows based on where the changes need to occur (eg pre-auth, IGL, FGL, claims processing etc)
• Map for gaps: sit-in with ops team members watching workflows related to provider management to assess for opportunities to capture more value

What you need to be successful

Qualifications:

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.