Healthcare Network Operations Manager

Job Description Summary:

The role requires to strategist across various area of Health area from providers, payers, and hospitals network with strong understanding of the trends, opportunities, and challenges.

To lead and manage the end-to-end operations of the healthcare provider network post-onboarding, ensuring seamless service delivery, robust Direct Billing operations, and strong alignment with claims processes and organizational standards.

This role is accountable for:

• Driving operational excellence across healthcare provider network

• Ensuring efficient Direct Billing and claims execution at provider level

• Strengthening provider performance and governance

• Delivering continuous improvement in service quality, cost, and operational efficiency

Job Description:

3.1 Network Operations Management

• Manage day-to-day operations of hospital and clinic network within the Direct Billing ecosystem

• Ensure providers adhere to claims submission processes, Direct Billing workflows, and service standards

• Act as primary operational focal point for healthcare providers

• Support provider onboarding validation to ensure operational readiness

3.2 Provider Performance Management

• Coordinate with Claims teams to ensure efficient end-to-end claims processing

• Monitor key metrics: TAT, accuracy, rejection/dispute rates

• Conduct performance reviews and corrective action plans

• Identify root causes of claims discrepancies and inefficiencies

3.3 Operational Excellence

• Drive process standardization and workflow optimization

• Support digital claims and automation initiatives

• Deliver training and ensure provider alignment with process updates

• Undertake projects / other work and duties allocated by management as and when required.

Job Accountability/ Trách nhiệm chính

• To support Senior Manager/Head in to reviewing the empaneling criteria, summarizing the result and provide recommendation on the intend.

• To revisit the hospitals’ location, hospital’s quality, the need of expansion or reduction due to business consideration and revise business strategy.

• To prepare report of analysis finding for the purpose of empaneling preparation in accordance to group guideline, prepare empaneling recommendation accordingly,

• To support manager in execution of action to further review and corresponding with watch list letter or eventually may proceed with delisting of provider/physician or medical specialist center.

Yêu cầu công việc

Job Requirements/ Yêu cầu

a. Qualification

Degree in Economics, Business Administrative, Business Management, and etc.

b. Experience

Preferably experience in Operations management, Insurance business and Business Strategic Planning and Health Management will be an advantage. Working insurance company or banking at managerial level for at least 5 years.

c. Knowledge, Skills & Attributes

Insurance/Legal/Health management and project management, Operational management, stakeholder coordination, problem-solving, analytical thinking

Possess knowledge on Life Insurance claims processing.

Computer literate and familiar with MS Excel, MS Word & MS PowerPoint.. Self-assured and results oriented

Quyền lợi

• Khác: Company's benefits.