Operations Director, Raffles Health Insurance

RafflesMedicalGroup (RMG) is the largest home-grown private healthcare provider in the region, started in 1976 in Singapore as a two-clinic operation but today, serves patients in five countries, 14 cities. It is the only private medical provider in Singapore that owns and operates a fully integrated healthcare organization comprising a tertiary hospital, network of family medicine and dental clinics, insurance services, Japanese and Traditional Chinese Medicine clinics, Raffles Health Longevity Centre and a consumer healthcare division. Raffles Hospital is the flagship of Raffles Medical Group. Our China footprint has expanded with the opening of our Chongqing, Beijing and Shanghai Hospital.

Raffles Health Insurance (RHI) was incorporated in 2004, commenced operations on 2 January 2005 as a general insurer and converted into a life insurer in March 2006 under the purview of the Monetary of Authority of Singapore. RHI is a wholly owned subsidiary of Raffles Medical Group and a leading healthcare insurance specialist in Singapore, supported by RMG's wide network of family medicine clinics and tertiary care private hospital, Raffles Hospital, to provide a fully integrated and coordinated healthcare for our policy owners and members. We strive to be the preferred healthcare partner and service provider, specializing in providing a healthcare financing solution to cater to your healthcare needs.

We are looking to hire an Operations Director for Raffles Health Insurance

Role Overview

The Operations Director is responsible for leading and overseeing the end-to-end operational functions of the health insurance business to ensure efficient, compliant, and customer-centric service delivery. The role drives operational excellence across policy administration, claims management, provider network operations, customer service, and operational risk management.

Reporting directly to the General Manager, the Operations Director plays a strategic leadership role in improving operational efficiency, strengthening service quality, ensuring regulatory compliance, and supporting the company's growth objectives.

Key Responsibilities

1. Operational Leadership and Strategy

• Develop and execute operational strategies aligned with the company's business objectives and growth plans.
• Provide leadership and direction across core operational functions including claims, policy administration, customer service, and provider management.
• Establish operational policies, procedures, and governance frameworks to ensure consistency and efficiency.
• Drive continuous improvement initiatives to enhance productivity, cost efficiency, and service quality.

2. Claims and Policy Administration

• Oversee the end-to-end claims management process including adjudication, payment processing, fraud detection, and claims analytics.
• Ensure claims are processed accurately, efficiently, and within defined service level agreements (SLAs).
• Oversee policy issuance, endorsements, renewals, and member administration processes.
• Implement process improvements and automation to streamline policy and claims operations.

3. Provider Network and Medical Operations

• Manage relationships with healthcare providers, hospitals, and clinics within the provider network.
• Ensure effective provider credentialing, contracting, and reimbursement processes.
• Monitor provider performance and cost management to ensure sustainability of the healthcare network.

4. Customer Service and Member Experience

• Lead the customer service function to ensure a high level of service delivery to policyholders and corporate clients.
• Implement service standards and operational KPIs to drive customer satisfaction.
• Develop initiatives to enhance member experience and service turnaround times.

5. Operational Risk and Regulatory Compliance

• Working with the Risk & Compliance team, ensure all operational processes comply with relevant regulatory requirements and internal policies.
• Establish controls to mitigate operational risks including fraud, data security, and compliance breaches.
• Support regulatory reporting and audits where required.

6. Digital Transformation and Process Improvement

• Champion digitalisation and automation initiatives to improve operational efficiency.
• Work closely with IT and business teams to implement operational systems and technology platforms.
• Utilise operational data and analytics to identify improvement opportunities.

7. Operational Performance Management

• Manage operational budgets and ensure cost-effective utilisation of resources.
• Track operational performance metrics including claims turnaround time, service levels, and cost efficiency.
• Provide regular operational performance reports to the General Manager.

8. Leadership and Team Management

• Lead, mentor, and develop the operations team to build strong operational capabilities.
• Foster a culture of accountability, continuous improvement, and customer focus.
• Ensure effective workforce planning and resource allocation across operational functions.

Qualifications and Experience

• Bachelor's degree in Business Administration, Healthcare Management, Insurance, or a related discipline.
• Minimum 12–15 years of experience in insurance or healthcare operations, with at least 5 years in a senior leadership role.
• Strong knowledge of health insurance operations, claims management, and provider network administration.
• Experience in operational transformation, process optimisation, and digital initiatives.
• Good understanding of regulatory requirements in the insurance industry.
• Proven ability to lead large operational teams and manage cross-functional stakeholders.

Key Competencies

• Strategic and operational leadership
• Process improvement and operational excellence
• Claims and policy administration expertise
• Regulatory and risk management awareness
• Financial and performance management
• Stakeholder and provider relationship management
• Strong analytical and decision-making skills

Office Location: 25 Tannery Lane, Singapore 347786

Please forward your resume to: [Confidential Information]

We regret that only short-listed candidate will be notified.

Thank you for your interest in Raffles Medical Group.