Senior Manager, Healthcare Management

Blue Cross

  • Hong Kong
  • Permanent
  • Full-time
  • 7 days ago
FIND YOUR 'BETTER' AT Blue CrossWe don’t simply believe in being ‘The Best’. We believe in better - because there’s no limit to how far ‘better’ can take us.We believe in empowering every one of our people to find their 'better' - in the work they do, the career they build, the life they live and the difference they make. So that together we can support even more people - including our own - to live Healthier, Longer, Better Lives.If you believe in better, we’d love to hear from you.About the Role Responsible for determining the validity and authorising settlement of group health insurance claimsResponsibilities:Operational Leadership
  • Lead the Pre-Assessment team for hospitalization and network claims
  • Oversee network management, credit facility services, and shortfall claims
  • Ensure operational excellence and regulatory compliance
  • Support ad hoc projects
Strategic Development
  • Drive the development of a comprehensive healthcare ecosystem aligned with Integrated Health Services (IHS) strategies and Value-Based Healthcare Management
  • Lead initiatives in network steerage, utilization management, and fee structure optimization
  • Develop clinical guidelines and digital care pathways to ensure consistent and quality care
Analytics & Risk Management
  • Investigate early claims and suspicious cases to mitigate fraud and abuse
  • Support the Head of Claims in implementing performance metrics and analytics
  • Collaborate with stakeholders to enable data-driven decision-making
Stakeholder Engagement
  • Strengthen relationships with medical providers, internal teams, and external partners
  • Represent the department in cross-functional projects and strategic forums
Requirements:
  • Bachelor’s degree or above preferrable in healthcare related;
  • 10 years’ relevant experience in medical insurance industry with solid managerial experience in medical claims assessment with clinical knowledge;
  • Professional qualification in FLMI, FLHC, etc. is an advantage.
  • Familiar with operation of medical claims and healthcare network providers
  • Excellent communication and interpersonal skills
  • Strong problem-solving abilities and attention to detail
  • Flexible and customer-oriented
  • Able to handle multi-task and work in a dynamic fast-paced environment
  • Fluent in English and Chinese (Cantonese) both in writing and verbal
  • Proficient in MS Office and Chinese Word Processing
Others:
  • You are required to obtain relevant license if your job involves in regulated activities
Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.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.

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