Head of TPA Operations

Tổng quan về công việc và trách nhiệm

- Cross-functional TPA Operations Coordination • Coordinate daily / weekly operations across Claims, Direct Billing, Customer Service, Policy Management and Data Analytics to ensure smooth handover, issue tracking and timely execution. - SLA Monitoring & Follow-up • Track SLA performance by function, identify delays or operational gaps, and follow up with responsible team leaders to ensure corrective actions are implemented. - Issue Tracking & Escalation • Maintain an operations issue log, follow up on pending actions, prepare escalation notes for Deputy GD and support timely resolution of client / insurer / broker feedback. - Process Discipline & Documentation • Support standard operating procedures, workflow clarification, template usage, internal trackers and reporting discipline across TPA Ops teams. - Operational Reporting • Prepare weekly / monthly operations dashboards, including SLA status, ageing cases, pending claims, guarantee letter performance, policy onboarding status, customer service trends and key risks. - Onboarding & Renewal Readiness Support • Coordinate with BDAM, Policy Management, Claims, CS and Direct Billing teams to prepare for new client onboarding, renewal peak periods and handover from insurers/brokers. - Continuous Improvement • Identify recurring pain points, propose practical process improvements, support system enhancement requirements and help monitor implementation. - Stakeholder Coordination • Support operational discussions with internal teams and, where appropriate, join client / insurer / broker meetings for follow-up on service issues and agreed action plans. - Lead / Support TPA Technology Transformation • Drive major TPA digital transformation projects, including system enhancement, AI-assisted claims adjudication, workflow automation and customer journey improvement. • Work closely with BA, in-house Tech, Data Analytics and TPA functional teams to define business requirements, prioritize enhancements, coordinate UAT, support rollout and measure impact on SLA, productivity, claims accuracy and customer experience. - Other tasks assigned by the Company.