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Medical Operations Specialist
2 months ago
About the Role
This is a unique opportunity to join Swiss Re's Medex Insights & Monitoring team in Hong Kong, where you will play a key role in supporting the team's focus on the Hong Kong market. As a Medical Operations Specialist, you will work closely with cross-functional teams, including Medical Doctors, Client Managers, Pricing Actuaries, Underwriters, Product, Solutions, Data Scientists, and Technical Accounting.
Operational Excellence & Portfolio Monitoring:
- 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 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 medex insights and monitoring related tasks, including operations review, portfolio monitoring, data analytics, best practices, portfolio benchmarking assessment, etc. both internally and to clients on a pre-agreed frequency.
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 Market 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 Managers to ensure best in class service to our Clients;
- To collaborate with cross-functional teams (medical pricing, underwriting, solutions, medical doctor) 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 Medex Insights & Monitoring Team 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.
About the Team
To support Medex Insights & Monitoring team with focus on Hong Kong market by providing full range of medical operations, insights sharing and portfolio monitoring 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, nursing, 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.
About Swiss Re
Swiss Re is one of the world's leading providers of reinsurance, insurance and other forms of insurance-based risk transfer, working to make the world more resilient. We anticipate and manage a wide variety of risks, from natural catastrophes and climate change to cybercrime. We cover both Property & Casualty and Life & Health. Combining experience with creative thinking and cutting-edge expertise, we create new opportunities and solutions for our clients. This is possible thanks to the collaboration of more than 14,000 employees across the world.
Our success depends on our ability to build an inclusive culture encouraging fresh perspectives and innovative thinking. We embrace a workplace where everyone has equal opportunities to thrive and develop professionally regardless of their age, gender, race, ethnicity, gender identity and/or expression, sexual orientation, physical or mental ability, skillset, thought or other characteristics. In our inclusive and flexible environment everyone can bring their authentic selves to work and their passion for sustainability.
