Healthcare Services Senior Manager (Quản lý Cấp cao Dịch vụ Chăm sóc sức khỏe)

Prudential's purpose is to be partners for every life and protectors for every future.

The incumbent is responsible for leading the overall Healthcare function, encompassing claims assessment and medical provider management, ensuring alignment with company strategy, operational standards, and regulatory requirements.

Job Description

• Lead and oversee end-to-end Healthcare operations, including claims assessment and medical provider network management, ensuring alignment with business objectives, policies, and regulatory requirements.

• Define and drive healthcare strategies covering service delivery, cost containment, risk management, and customer experience improvement.

• Provide governance and oversight for claims adjudication and provider management processes, ensuring quality, SLA adherence, and compliance with audit and risk frameworks.

• Drive cross-functional collaboration with NBUW, PD, Marketing, Agency, and other stakeholders to manage risk exposures, improve product design, and enhance customer value proposition.

• Lead engagement with external stakeholders, including medical providers and TPA, to ensure service quality, effective partnership, and alignment with company standards.

• Oversee identification and management of fraud, waste, and abuse (FWA) trends, leveraging data insights to recommend strategic actions and preventive measures.

• Drive healthcare-related projects and initiatives, including process transformation, system enhancement, and service innovation, ensuring effective implementation and measurable outcomes.

• Oversee provider network strategy, including empaneling, contract management, performance monitoring, and service quality governance.

• Lead organization-wide initiatives to enhance customer experience across the healthcare journey, including claims servicing and provider interactions.

• Manage and develop leadership capabilities within the team, ensuring effective performance management, succession planning, and capability building.

Job Accountability

• The incumbent leads the overall Healthcare function, ensuring integrated claims assessment and provider management to deliver high-quality, compliant, and efficient services.

• The role drives cross-functional collaboration and stakeholder engagement to manage risks, monitor abuse trends, optimize costs, and enhance customer experience, while ensuring effective governance, performance, and continuous improvement across Healthcare operations.