Senior Claims Operations Specialist

Do meaningful work with us. Every day.

At Amplify Health, we’re looking for individuals with ambition, resilience and passion for healthcare, insurance, wellness  and digital technology. As a fast-growing business with the ambition of making people and communities across Asia healthier, we have exciting career opportunities available to help us achieve our vision.

Summary:
Based in Singapore and reporting to the Claims Operations Lead, you will be responsible for shaping and implementing the in-market strategy for Amplify Health’s claims operations solutions.
You will actively manage the client relationships, as well and external stakeholders, including providers and regulators, to align transformation efforts with industry standards and requirements.
Key to success in this role will be the ability act the key conduit between the numerous business stakeholders and technical teams to translate business needs into actionable solutions for clients.

Responsibilities:

Strategy Development and Execution: 

• Working closely with the Claims Operations Lead and broader team, develop and implement a comprehensive in-market strategy for Amplify Health in Singapore to drive impactful transformation of claims operations for our clients, who are healthcare payors (private insurers, public payors, other payors) ensuring alignment with the client’s organisational objectives.  

• Identify opportunities to optimise claims processing through organisational 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.  

• 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.  

• Track Key Performance Indicators (KPIs) to measure transformation outcomes, value realization, and savings delivery. 

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 Optimisation:  

• 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.   

• Collaborate with client stakeholders to adapt processes and SOPs, ensuring alignment with local regulations and operational needs. 

Change Management:  

• Lead organisational 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.  

• Identify and close operational gaps through workflow observation, root cause analysis, and process improvement initiatives. 

Fraud, Waste, and Abuse Management:  

• Implement and operationalise advanced solutions to detect, prevent, and mitigate fraud, waste, and abuse (FWA) within medical claims workflows.  

• 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.

Experience and Qualifications:

• 7-8+ 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 utilising AI, automation, and analytics in claims processes.  

• Familiarity with claims adjudication platform design frameworks, AI-driven FWA detection tools, and analytics capabilities.

• Bachelor’s degree in Engineering, Business Administration, Healthcare Management, Health Administration/Public Health or a related field; MBA or advanced degree preferred. 

• Prior consulting experience (strategy, operations, or health systems) is preferred.  

• Excellent communication and stakeholder management skills; fluency in English and local language is preferred.

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