The successful candidate will be responsible for driving transformation and management of claims to execute solutions to reduce Fraud, Waste and Abuse and improve portfolio and customer experience. S/he will be responsible for collaborating with global, regional & country stakeholders to review claims automatic adjudication solutions, work with data analytics team to control Fraud, Waste and Abuse as well as developing control measures to manage TPA partnership to drive a competitive advantage for Manulife.
Collaboration across the various functions of operations, pricing, risk, proposition marketing, advanced analytics and distribution will be key in forming the approach. This role will require frequent interfacing with regional and country level COOs and functional executives and getting “on the ground” to better assess and drive success.
Responsibilities:
- Drive transformational change on end-to-end claim processing using technologies to increase straight through processing under the claims value stream.
- Partner with Advanced Analytics team to monitor portfolio experience and implement measures to reduce fraud, waste and abuse.
- Establishing selection criteria, key control measures, key performance indicators, and bonus/penalties perimeters of TPA partnership.
- Undertake a review of the organization structure to position claim as a competitive advantage.
- Partner with functional leaders to drive innovative solutions to build out claims operating model to support local business growth goals.
- Develop a comprehensive playbook that defines the claims requirements/best practices to accelerate sustainable margin expansion and growth.
Knowledge/Skills/Competencies/Education:
- Knowledge in life insurance and health insurance
- Strong operational and analytical background
- Track record for delivering change management and transformational initiatives
- Ability to plan, control, direct, and work cross functionally across multi-discipline functions
- Ability to anticipate business requirements around strategy, structure, culture and ability to translate new skills/organization required to lead new function
- Good interpersonal skills; a forthright communicator able to build and maintain enthusiasm; fluency in English
- Proven track record in establishing and managing cross-business and external partnership
- Strong negotiation and influencing skills
- 15+ years of related experience (reinsurance and insurance claims & operations experience)
- University degree required, advanced degree a plus
