Manager - Quality Assurance & Operations (Medical Claims)

About the Job

Assist HOD in managing daily claims operations, including workload allocation, manpower planning, productivity monitoring, SLA achievement, issue escalation. Conduct quality reviews, identifying and addressing processing errors, providing coaching and feedback, driving continuous improvement initiatives to enhance service quality, operational efficiency, and customer satisfaction.

• Manage daily medical claims operations to ensure timely processing and achievement of service level agreements (SLAs).
• Monitor team productivity, workload distribution, and resource planning to optimise operational efficiency.
• Oversee quality control activities to ensure claims are assessed accurately, consistently, and in compliance with policy provisions and regulatory requirements.
• Review quality audit findings and operational performance metrics, identify gaps, and implement corrective and preventive actions.
• Lead, coach, and develop staff to enhance technical competency, quality standards, and overall performance.
• Drive continuous process improvement initiatives to improve claims quality, operational efficiency, customer experience, and cost effectiveness.
• Prepare and present management reports on operational, quality, and performance outcomes, including key risks and improvement opportunities.

We are looking for people with

• Degree in Nursing or Healthcare related discipline with at least 5 years of experience in a public/private hospital is essential.
• Not less than 10 years of working experience in the hospital environment, managed care and medical insurance.
• Knowledge of healthcare billing and medical terminology and MMA coding.
• Analytical and conflict resolution skills.
• Planning and organisation skills.
• Demonstrates alignment with the organisation's core values through expected behaviours.
• High level of integrity, takes accountability of work and good attitude over teamwork.
• Takes initiative to improve current state of things and adaptable to embrace new changes.

How you succeed

• Champion and embody our Core Values in everyday tasks and interactions.
• Demonstrate high level of integrity and accountability.
• Take initiative to drive improvements and embrace change.
• Take accountability of business and regulatory compliance risks, implementing measures to mitigate them effectively.
• Keep abreast with industry trends, regulatory compliance, and emerging threats and technologies to understand and highlight potential concerns/ risks to safeguard our company proactively.

Who we are

Founded in 1908, Great Eastern is a well-established market leader and trusted brand in Singapore and Malaysia. With over S$100 billion in assets and more than 16 million policyholders, including 12.5 million from government schemes, it provides insurance solutions to customers through three successful distribution channels – a tied agency force, bancassurance, and financial advisory firm Great Eastern Financial Advisers. The Group also operates in Indonesia and Brunei.

The Great Eastern Life Assurance Company Limited and Great Eastern General Insurance Limited have been assigned the financial strength and counterparty credit ratings of AA- by S&P Global Ratings since 2010, one of the highest among Asian life insurance companies. Great Eastern's asset management subsidiary, Lion Global Investors Limited, is one of the leading asset management companies in Southeast Asia.

Great Eastern is a subsidiary of OCBC, the longest established Singapore bank, formed in 1932. It is the second largest financial services group in Southeast Asia by assets and one of the world's most highly-rated banks, with an Aa1 rating from Moody's and AA- by both Fitch and S&P. Recognised for its financial strength and stability, OCBC is consistently ranked among the World's Top 50 Safest Banks by Global Finance and has been named Best Managed Bank in Singapore by The Asian Banker.

To all recruitment agencies: Great Eastern does not accept unsolicited agency resumes. Please do not forward resumes to our email or our employees. We will not be responsible for any fees related to unsolicited resumes.