Within AHI, the Partnership and Reinsurance business represents c. 60%. Within the P and R model, the servicing is performed by Partners or TPAs, with the partnership and reinsurance Operations team in charge of ensuring that the delegated servicing activities, and more specifically claim handling processes, are aligned to the expectations of the (re)insurer of this business (AXA Health Insurance and AXA Health Re), the aim being to minimise operational risk and control claim costs.
This role has ultimate responsibility within AHI for all operational and servicing delivery for Insurance Partners, in the context of the Partnership and Reinsurance business, including management of Service Partners (TPAs), provision of a global medical claims service, review and approval of claims and control and auditing function. This is a global role with team members based across the world (majority in Singapore, France and UK).
The role will also support product development and design for existing and new Insurance.
Implementing new claims practices and leveraging innovation and technology to improve Partnership and Reinsurance service offering to Clients and claims related value-adds as well as portfolio profitability is a priority.
About the Role
We are seeking an experienced Head of Partnership and Reinsurance Operations to lead all operational and servicing activities related to Insurance Partners within the Partnership and Reinsurance business.
In this model, claims servicing is delegated to strategic Partners and Third-Party Administrators (TPAs). This role has ultimate accountability for ensuring that all delegated claims and operational activities are aligned with AXA Health Insurance and AXA Health Re standards, with the objectives of minimising operational risk, controlling claims costs and enhancing portfolio profitability.
Reporting directly to the Deputy CEO and COO of AXA Health International, you will lead a global, multi-location team (primarily based in Singapore, France and the UK) and play a critical role in shaping claims strategy, partner performance, risk management and service innovation across the portfolio.
This role also contributes to product design and development for existing and new insurance solutions, and drives continuous improvement through new claims practices, technology and innovation.
Key Responsibilities
Partner Operations & Service Delivery
-
Provide end-to-end operational and claims support to Insurance Partners
-
Manage TPAs on behalf of Partners, with regular performance monitoring against agreed SLAs
-
Support the onboarding of new Partners, including:
-
Claims process design
-
Training delivery
-
Support in TPA selection and contracting
-
Governance, regulatory and compliance requirements (due diligence, data protection, security and annual reporting)
Claims Management, including Fraud, Waste and Abuse (FWA)
-
Ensure robust global management of all Partner-Controlled Claims, with clearly defined and agreed processes
-
Provide medical expertise and claims adjudication to protect (re)insurer risk
-
Ensure all controlled claims are authorised in line with contractual arrangements
-
Deliver required reporting to (re)insurers and Claims Management Committees
-
In collaboration with the Claim Technical Excellence team, define and oversee the FWA framework
-
Set annual FWA targets and monitor delivery
TPA Control and Audit
-
Oversee TPA performance and contractual compliance
-
Conduct risk-based TPA audits, including:
-
Compliance with AXA Group standards, Outsourcing Policy and Information Security requirements
-
Claims audits
-
Maintain and enhance audit policies in collaboration with Claim Technical Excellence
-
Deliver audit reports in line with AXA standards
-
Ensure audit findings are reviewed at Claims Management Committees and that corrective action plans are implemented and tracked
Global Network and Outsourced Activities
-
Liaise with and support the Global Medical Network team
-
Oversee the Protection business outsourced to a third party
