Medical Insurance Operations Manager

2 weeks ago

Makati City, National Capital Region, Philippines AXA Philippines Full time

Job Purpose

The Medical Insurance Operations Manager is responsible for planning, directing, and coordinating medical and health services of the company. This includes management of TPA relationship for hospital network development, management of networks of medical specialists, review of processes, and engagement of new partners and processes for medical health services.

The role requires providing assistance in hospital / clinic / doctor coordination during consultations/admissions of clients as may be needed.

Critical Accountabilities:

  1. Supervise and ensure smooth administration of health insurance by coordinating operational processes for services related to the company's medical portfolio.
  • Access to medical network
  • Claims administration
  • Service delivery of well-being/health services (e.g. tele-consultation, wellness & prevention programs)
Provide operational support: work with operations (UW, etc.) and front line teams (Branch, Customer Care) to ensure product benefit and service delivery.Management of processes across the health journey—define service standards and operating policies towards improving efficiency and quality in delivering customer service; integrate provider services, in-house operations, and governance.Continuously review and evaluate the efficiency and effectiveness of service delivery methods, procedures, administrative and support systems; identify areas of improvement and define implementation strategies.

Educational Qualifications

  • Graduate in business management, medical, paramedical or other related courses.
  • Insurance risk management or claims management qualifications will be an advantage.

Relevant Experience

  • Minimum 5 years of experience in managing medical / health insurance operations or administration from HMO or insurance company.
  • Experience in setting up and/or managing operations processes supporting medical or HMO products, managing networks of Medical Specialist.
  • Experience in claims management and/or medical background preferred.
  • Expert knowledge of the healthcare insurance market and relevant practices and regulations, and product solutions.

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