Senior Claims Operations Specialist at AIA Group Ltd

Hong Kong, Hong Kong Island, Hong Kong S.A.R. -

Full Time

Start Date

Immediate

Expiry Date

13 Aug, 26

Salary

0.0

Posted On

15 May, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Operations, Strategy Development, Process Optimisation, Stakeholder Engagement, Change Management, Fraud Waste and Abuse Management, Provider Risk Management, AI Implementation, Data Analytics, Healthcare Insurance, Clinical Operations, KPI Tracking, Regulatory Compliance, Project Management, Cross-functional Leadership, Business Analysis

Industry

Insurance

Description

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. Based in Hong Kong and reporting to the Claims Operations Lead, the Claims Operations Specialist is responsible for implementing Amplify Health’s in‑market strategy for claims operations solutions. The role serves as a critical interface between client relationships, external stakeholders, including providers and regulators, and internal stakeholders 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 complex business needs into actionable operational, process, and technology solutions for clients. As Claims Operations Specialist, Hong Kong, at Amplify Health you will play a key role in shaping the future of Hong Kong’s claims management process. You will be working with some of the largest healthcare payors in the country, as well as providers and regulators to leave a lasting impact on the industry. Responsibilities Strategy Development & Execution Partner with the Claims Operations Lead to develop and implement an in‑market strategy that drives end‑to‑end transformation of claims operations and claims risk management. Identify opportunities to enhance operational efficiency through organisational redesign, process optimisation, automation, and technology adoption. Drive initiatives to increase straight-through processing (STP), reduce manual effort, and enhance adjudication accuracy. Track key KPIs to measure value realisation and operational effectiveness. 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 transformation of end‑to‑end claims processes with a focus on cost and operational efficiency. Implement best‑practice frameworks for quality assurance, compliance, and medical claims management. Develop, monitor, and continuously refine KPIs to support improvement cycles. Stakeholder Engagement Serve as a key liaison between underwriting, actuarial, provider management, technology, and customer service teams, to ensure seamless claims operations. Translate complex business requirements into actionable technical and operational specifications. Engage with regulators and providers to ensure alignment with industry standards and evolving regulatory expectations. 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 (FWA) Management Deploy advanced analytical and AI-enabled solutions to detect, prevent, and mitigate FWA. Collaborate with Special Investigation Units and analytics teams to continuously refine detection models. Recommend enhancements to audit frameworks and oversee tracking of value delivery. Provider Risk Management Partner with provider management and claims teams to design and embed solutions that operationalise provider agreements. Translate provider requirements into SOPs, system rules, and workflow enhancements across pre‑auth, adjudication, IGL/FGL, and claims processing. Conduct workflow observations to identify opportunities to strengthen provider risk mitigation and value capture. Candidate Profile Experience and Qualifications Over 7 years of experience in provider management, clinical operations, medical claims, healthcare insurance, or related fields. Demonstrated experience leading claims transformation, operations improvement, or provider-management change initiatives. Strong background in leveraging automation, analytics, and AI within claims workflows. Familiarity with claims adjudication platforms, FWA detection tools, and data-driven operations design. Prior experience in consulting (strategy, operations, health systems) preferred. Medical degree (MD/MBBS) or health science advantageous; MBA or advanced degree preferred. Competencies & Core Characteristics: We are seeking a leader who embodies the following competencies and characteristics essential for success in our scale-up environment: Technical Domain Expertise: Demonstrates deep understanding of medical claims operations, provider risk frameworks, and healthcare insurance processes. Applies technical knowledge to design scalable, compliant, and high‑quality solutions. Ensures decisions are grounded in clinical, operational, and regulatory accuracy. Strategic Architect: Thinks systematically and anticipates long-term implications when designing policies, processes, and solutions. Develops clear strategic pathways that align operational execution with Amplify Health’s broader business objectives. Unifier & Cross-Functional Influencer: Builds strong relationships across product, technology, actuarial, commercial, and provider teams. Facilitates alignment among diverse stakeholders and drives consensus in complex, multi-party environments. Coach & Talent Multiplier: Elevates team capability by mentoring colleagues, sharing best practices, and enabling continuous learning. Cultivates a high-performance culture grounded in accountability and collaboration. Data-Driven Decisiveness: Applies analytical rigor to interpret trends, diagnose root causes, and drive evidence-based decisions. Uses KPIs, models, and performance dashboards to guide priorities and measure outcomes. Resilient Operator: Performs effectively in high‑ambiguity, fast‑paced environments. Adapts rapidly to evolving client needs, market dynamics, and organisational shifts while maintaining clarity and execution focus. Customer-Obsessed Advocate: Prioritises customer impact in all decisions. Builds trusted relationships with clients, understands operational pain points, and champions solutions that deliver measurable, sustainable value. Insatiable Curiosity: Constantly seeks new insights, innovations, and industry best practices. Demonstrates a growth mindset and embraces emerging technologies, methodologies, and ideas to elevate outcomes. You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date. At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone. It's about finding new ways to not only better people's lives, but to better the communities and environments we live in. As the largest listed company on the Hong Kong Stock Exchange, we’ve been proudly making a difference for people and communities across Asia for over a century. And we build on this every day with our ambition to engage one billion people to live Healthier, Longer, Better Lives by 2030. If you work at AIA, you play an important part in this movement. Which is why we give you every opportunity to learn, grow and shape your career - your way. Inspiring and supporting you to thrive - not just at work, but in life. Believe in better with AIA. View our AIA LinkedIn page Bring your difference to AIA

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Responsibilities

Implement the in-market strategy for claims operations by optimizing processes and deploying AI-driven technology solutions. Act as the primary liaison between technical teams, clients, and regulators to align transformation efforts with industry standards.