FIND YOUR 'BETTER' AT Blue Cross

We 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 claims

Responsibilities:

Operational Leadership

Lead the Pre-Assessment team for hospitalization and network claimsOversee network management, credit facility services, and shortfall claimsEnsure operational excellence and regulatory complianceSupport ad hoc projects

Strategic Development

Drive the development of a comprehensive healthcare ecosystem aligned with Integrated Health Services (IHS) strategies and Value-Based Healthcare ManagementLead initiatives in network steerage, utilization management, and fee structure optimizationDevelop 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 abuseSupport the Head of Claims in implementing performance metrics and analyticsCollaborate with stakeholders to enable data-driven decision-making

Stakeholder Engagement

Strengthen relationships with medical providers, internal teams, and external partnersRepresent 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 providersExcellent communication and interpersonal skillsStrong problem-solving abilities and attention to detailFlexible and customer-orientedAble to handle multi-task and work in a dynamic fast-paced environmentFluent in English and Chinese (Cantonese) both in writing and verbalProficient 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.