Claims Manager

We don’t simply believe in being ‘The Best’. We believe in better - because there’s no limit to how far ‘better’ can take us.

We believe in empowering every one of our people to find their 'better' - in the work they do, the career they build, the life they live and the difference they make. So that together we can support even more people - including our own - to live Healthier, Longer, Better Lives.

• Design and operationalize the new operating model for the Claims Function, integrating adjudication, automation, validation, auditing, and investigation functions.
• Define and implement the Model Office’s governance framework, performance systems, and end-to-end processes.
• Develop Standard Operating Procedures, service level targets, and escalation mechanisms to ensure operational experience.

• Define roles, structures, and competency frameworks for adjudicators, auditors, and specialized units for special handling and investigative units.
• Lead recruitment, onboarding, and capability-building efforts for the Model Office workforce.
• Foster a culture of accountability, continuous improvement, and operational discipline.

• Establish key performance indicators (KPIs), service level agreements (SLAs), and quality standards aligned with automation-driven operations.
• Oversee calibration and optimization of auto-adjudication logic, exception handling, and system configuration.
• Implement reporting mechanisms and analytics to track performance, identify issues, and drive corrective action.

• Implement governance and compliance frameworks to ensure integrity and operational control.
• Drive the integration of Fraud, Waste, and Abuse (FWA) detection and investigation practices within the Model Office.
• Establish monitoring and audit mechanisms to ensure potential operational risks and exceptions are appropriately reviewed and addressed.

• Act as the primary liaison between transformation teams, delivery partners, and executive stakeholders.
• Leader organizational change initiatives to ensure operational readiness and sustainability.
• Promote alignment, communication, and accountability across teams and leadership levels.

At MediCard, we believe that diversity and inclusion are essential to fostering innovation, collaboration, and growth. We are committed to creating a workplace where everyone, regardless of gender, race, ethnicity, age, sexual orientation, disability, or any other characteristic, feels valued and empowered to contribute their unique perspectives and talents.

Our inclusive hiring practices ensure that we attract, hire, and retain the best talent from all backgrounds. We strive to provide equal opportunities for all candidates and promote a culture of respect, fairness, and transparency. We are dedicated to continuously improving our processes and policies to eliminate biases and barriers, ensuring that every employee has the support and resources they need to thrive.

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

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