Trách nhiệm chính

• Serve as subject matter expert for healthcare claims assessment, benefit interpretation, policy provisions, and end-to-end operational workflows.
• Review complex or escalated claims and provide clear guidance to support accurate and consistent decisions.
• Identify recurring issues, control gaps, rework drivers, and opportunities to improve quality, efficiency, and customer outcomes.
• Develop and maintain standard operating procedures, process documentation, and work instructions.
• Support adherence to internal policies, regulatory requirements, audit expectations, service-level agreements, and quality standards.
• Represent Claims Operations in system enhancements, healthcare claims projects, and transformation initiatives.
• Support requirements gathering, process mapping, solution walkthroughs, and impact assessments.
• Review business and functional requirements, providing operational input to confirm that claims needs and controls are addressed.
• Collaborate with business stakeholders, IT teams, and vendors throughout design, testing, deployment, and stabilization.
• Support workshops, issue-resolution discussions, deployment readiness, and post-go-live hypercare activities.
• Prepare, review, and execute end-to-end UAT scenarios and test cases based on business requirements and real claims journeys.
• Validate system functionality, integrations, and auto-adjudication outcomes against expected business results.
• Log clear, reproducible defects in JIRA, attach supporting evidence, track resolution, and complete retesting through closure.
• Coordinate testing activities with business users and project teams to ensure adequate coverage, data readiness, and timely execution.
• Assess test results, open defects, and operational risks to support UAT sign-off and deployment-readiness recommendations.
• Perform post-deployment smoke testing, production validation, and hypercare support as required.
• Coordinate with Claims Operations, business users, IT teams, and external vendors to resolve issues and deliver agreed outcomes.
• Participate in requirements reviews, defect triage, solution walkthroughs, and operational-readiness discussions.
• Maintain clear action logs, follow up on commitments, and elevate risks or delays in a timely manner.
• Build constructive working relationships across business and technical teams through clear, professional communication.

Yêu cầu

• Bachelor’s degree in Insurance, Business Administration, Healthcare, Information Technology, or a related discipline.
• Three to five years of experience in healthcare insurance claims operations, including hands‑on claims assessment or administration.
• Sound understanding of healthcare claims workflows, policy provisions, benefit rules, and medical terminology.
• Experience interpreting and validating healthcare claims auto‑adjudication (AA) rules, including rule results, approved and disallowed amounts, benefit limits, and expected claim outcomes.
• Hands‑on experience in UAT or system‑enhancement initiatives, including test‑case preparation and execution, evidence capture, defect retesting, and sign‑off support.
• Proficiency in JIRA for test execution, defect logging, prioritization, tracking, retesting, evidence management, and closure; experience with JIRA Xray is an advantage.
• Experience working effectively with business users, IT teams, project teams, and external vendors.
• Strong analytical, problem‑solving, stakeholder‑management, collaboration, and follow‑through skills.

Yêu cầu ưu tiên

• Strong spoken and written English communication skills are preferred.

Mức lương

• Salary not disclosed.

Phúc lợi

• No benefits information provided.

Hình thức làm việc

• Onsite

Thông tin khác

• Location: Thành phố Hồ Chí Minh, Vietnam
• Working Arrangement: In Office