Healthcare Network Operations Manager (Quản lý Vận hành Hệ thống CSYT)

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

The role requires a strategist across various areas of Health 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.

Job Description

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

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

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

• 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 Requirements

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