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Beijing, 11, CN

Medical Operations Expert


About Swiss Re

Swiss Re is one of the world’s leading providers of reinsurance, insurance and other forms of insurance-based risk transfer, working to make the world more resilient. We anticipate and manage a wide variety of risks, from natural catastrophes and climate change to cybercrime.

At Swiss Re we combine experience with creative thinking and cutting-edge expertise to create new opportunities and solutions for our clients. This is possible thanks to the collaboration of more than 13,000 employees across the world.

We offer a flexible working environment where curious and adaptable people thrive. Are you interested in joining us?


About the Role

To support Asia L&H Medical Operations team with focus on China market by providing full range of Medical Operations related technical expertise and consulting services in respect of medical product value chain and operation strategy throughout Life & Health business of Swiss Re in People's Republic of China.


Key Accountabilities


  • To provide managed care consulting support to clients including areas such as healthcare insurance solutions, innovative product development, insurtech solutions, network consulting and contracting, provider profiling, medical management programs, pharmaceutical management, and TPA selection and operations.
  • To support the Business Unit in new business tenders and in management of renewals of business, and in promoting team profile, value proposition and expertise in PRC
  • To create and maintain a positive relationship with senior management at clients (COOs, Product Development, Claims managers) to help SR manage our reinsured portfolio and to help us win new business.
  • To position SR as thought leader and influencer for claims management and medical operations in the China market.



  • To work closely with Client Markets to ensure best in class service to our Clients;
  • To collaborate with Pricing and Underwriting team for portfolio data analysis and interpretation with appropriate feedback for future product development, risk management strategies and pricing as well as suggest appropriate interventions to improve the portfolio's overall experience.
  • To effectively bring and work on best practices which may be used in medical operations teams in other countries.
  • To assess the impact of any regulatory changes that may impact the business or the portfolio or product development and present the same to internal teams


Operational Excellence:

  • To effectively manage SR claim liability through identifying and implementing appropriate client and claims management / risk management strategies within the terms and conditions of the policy and pricing assumptions.
  • To develop, articulate, and to maintain Swiss Re best practice and guidelines for product risk appetite, portfolio / provider / TPA / and operational infrastructure.
  • To ensure the data integrity of systems/databases for all claims adjudicated or assessed.
  • To assess and process claims using the Claims Manager tool in accordance with operating procedures as required.
  • To prepare and present analytics reports, best practices, portfolio benchmarking assessment etc. both internally and to clients on a pre-agreed frequency.


About the Team

Asia L&H Medical Operations team


About You

Education & Working Experience

  • Formal qualification in business, healthcare, insurance, risk management, finance or economics;
  • 10 – 15 years of work experience in direct insurer, reinsurance companies, third party administrator (TPA) companies and/or healthcare groups in China, overseas experience a plus;
  • Experience with medical indemnity insurance product design and claims definitions, provider or TPA contracting
  • Significant prior experience with medical insurance, healthcare operations and/or claims management strategy; clinical background a plus, but not mandatory.
  • Prior experience working with or for claims operations, underwriting, product development, and/or pricing team;
  • Auditing experience and reporting capabilities a plus.


Key Skills & Knowledge

  • Ability to use sound Medical Operations knowledge in a commercial environment;
  • Fundamental understanding and knowledge of the PRC insurance and reinsurance industry and knowledge of the main products and services offered by various insurance and reinsurance companies;
  • Excellent knowledge in Medical Operations UW/Claims management and medical management programs;
  • Excellent interpersonal, communication and influencing skills.
  • Organization, prioritization and planning skills;
  • Training and/or presentation skills and experience.
  • Excellent interpersonal, communication and influencing skills;
  • Organizational, data analytical, training and presentation skills.
  • Excellent verbal and written communication skills in Mandarin; Good command of English communication skills a plus but not mandatory.
  • Strong data analytical skills a plus

Reference Code: 94824