The Head, Medical Insurance Portfolio Management is a senior leadership role responsible for driving the strategic, technical, and operational direction of the company's medical insurance portfolio. This role oversees sustainability of medical insurance products via repricing exercises, effective cost containment and strong stakeholder communication aligned to evolving regulatory requirements.
Key Responsibilities
- Lead repricing exercises, including end-to-end execution, governing policy and procedure maintenance and regulatory filing and engagement activities.
- Oversee claims experience analysis and regulatory reporting for medical insurance products.
- Drive cost containment initiatives, including fraud/waste/abuse controls and strategic partnerships with panel hospitals and healthcare providers.
- Manage customer and sales force communication on medical insurance business.
- Oversee claims data quality and reporting, supporting preparations for DRG implementation.
- Provide leadership and cross-functional collaboration with product development, data analytics and operations on the medical insurance portfolio.
Qualifications
- Degree in Actuarial Science or related fields.
- 10+ years experience in medical and health insurance, actuarial pricing, or medical management.
- Strong knowledge of medical and health insurance regulations, claims, and provider management.
- Leadership experience and strong analytical, communication, and stakeholder engagement skills.
