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Hong Kong, Hong Kong SAR, HK

Medical Operations Team Lead


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

This role works closely with cross-functional teams including Medical Doctors, Underwriters, Client Managers, Pricing Actuaries, Product Solutions, Data Analytics, Technical Accounting and other Asia markets under Asia Life & Health line of business.

Key Accountabilities

  • To provide managed care consulting support to clients including areas such as medical 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, innovative product development and in promoting team profile, value proposition and expertise in Hong Kong, PRC, and SEA markets

  • To create and maintain a positive relationship with senior management at clients (COOs, Product Deve lopment, Claim Directors) to help SR manage our reinsured portfolio and to help us win new business.

  • To position SR as thought leader and influencer for medical expenses claims management and medical operations in the markets in which we operate.



  • To work closely with Client Markets to ensure best in class service to our Clients;

  • To collaborate with Costing, Underwriting and Solutions teams 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 SwissRe's internal claims management 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

To support Asia L&H Medical Operations team and the Hong Kong and Beijing L&H Products teams in providing Medical Operations related advice and technical expertise in respect to product initiatives and strategy throughout Life & Health business of Swiss Re in Hong Kong, People's Republic of China and SEA.


About You

Key Skills & Knowledge

  • Excellent technical knowledge in medical expenses claims management and medical management programs;
  • Auditing experience and reporting capabilities a must.
  • Experience with medical insurance product design and claims definitions, provider or TPA contracting
  • Ability to use sound Medical Operations knowledge in a commercial environment;
  • Fundamental understanding and knowledge of Asia PMI and Reinsurance markets, and knowledge of the main products and services offered by various insurance and reinsurance companies;
  • Excellent interpersonal, communication and influencing skills.
  • Organization, prioritization and planning skills;
  • Good data analytical skills
  • Training and/or presentation skills and experience.


Candidate Requirements

  • Formal qualification in business, financial services,  and/or health discipline;
  • 10 - 15 years of work experience in direct/ reinsurance companies / TPA in Asia; overseas experience a plus;
  • Significant prior experience with medical expenses claims management;
  • Prior experience working with or for insurance operations, underwriting, product development. and/or pricing team;
  • Excellent oral and written communication skills in English, Cantonese, and Mandarin;
  • Excellent interpersonal. communication and influencing skills;
  •  Clinical background a plus, but not mandatory.

Reference Code: 103846 


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