Claims Operations Specialist

About the Company

Amplify Health is Asia’s leading health technology and analytics organisation, providing our customers with integrated solutions to make healthcare more accessible, affordable and effective across the region. We offer a unique B2B business model and integrated stack of SaaS-based products, PaaS-based HealthTech launchpad and DaaS-based on-demand data offerings to deliver impact to our customers across the healthcare value-chain. Our joint-venture partners, AIA and Discovery, have provided us with the foundations and a platform that truly differentiates us from our competitors.

We aim to be the trusted custodian of Asia's largest repository of health data, unifying financial, clinical, operational and behavioural data to empower our customers with insights that highlight opportunities to deliver better value and care outcomes.

About the Role

Based in Thailand and reporting to the Claims Operations Lead, the Claims Operations Specialist is responsible for implementing Amplify Health’s in‑market strategy for claims operations solutions. The role serves as a critical interface between client relationships, external stakeholders (including providers and regulators), and internal stakeholders to align transformation efforts with industry standards and requirements. The role translates complex business needs into actionable operational, process, and technology solutions for clients and works with healthcare payors, providers and regulators.

Responsibilities

• Strategy Development & Execution: partner with the Claims Operations Lead to develop and implement an in‑market strategy that drives end‑to‑end transformation of claims operations and claims risk management; identify opportunities for organisational redesign, process optimisation, automation and technology adoption; drive initiatives to increase straight-through processing (STP), reduce manual effort, and enhance adjudication accuracy; track KPIs to measure value realisation and operational effectiveness.
• Technology and Innovation: collaborate with Amplify Health’s product teams and client technology/data teams to design, deploy and align technology/data solutions with operational needs; work closely with technology teams to deploy AI-driven solutions for fraud detection, waste minimization and claims adjudication; oversee integration of advanced analytics tools and predictive models; evaluate emerging technologies and partner with insurtech vendors.
• Process Optimisation: lead transformation of end‑to‑end claims processes with a focus on cost and operational efficiency; implement best‑practice frameworks for quality assurance, compliance and medical claims management; develop, monitor and continuously refine KPIs to support improvement cycles.
• Stakeholder Engagement: serve as a liaison between underwriting, actuarial, provider management, technology and customer service teams; translate complex business requirements into technical and operational specifications; engage with regulators and providers to ensure alignment with industry standards and evolving regulatory expectations; collaborate with client stakeholders to adapt processes and SOPs to local regulations and operational needs.
• Change Management: lead organisational change efforts to foster a culture of innovation and adaptability; provide training and support to ensure smooth adoption of new processes and technologies; communicate transformation goals, progress and outcomes to leadership and key stakeholders; identify and close operational gaps through workflow observation and root cause analysis.
• Fraud, Waste and Abuse (FWA) Management: deploy advanced analytical and AI-enabled solutions to detect, prevent and mitigate FWA; collaborate with Special Investigation Units and analytics teams to refine detection models; recommend enhancements to audit frameworks and oversee tracking of value delivery.
• Provider Risk Management: partner with provider management and claims teams to design and embed solutions that operationalise provider agreements; translate provider requirements into SOPs, system rules and workflow enhancements across pre‑auth, adjudication, IGL/FGL and claims processing; conduct workflow observations to identify opportunities to strengthen provider risk mitigation and value capture.

Qualifications