About Amplify Health
Who We Are
Amplify Health is Asia’s leading health technology and analytics organisation, providing our customers with integrated solutions to make healthcare more accessible, affordable and effective across the region.
We offer a unique B2B business model and integrated stack of SaaS-based products, PaaS-based HealthTech launchpad and DaaS-based on-demand data offerings to deliver impact to our customers across the healthcare value-chain.
Our joint-venture partners, AIA and Discovery, have provided us with the foundations and a platform that truly differentiates us from our competitors and allows us to build and deploy products at a scale and quality that few can match.
We aim to be the trusted custodian of Asia’s largest repository of health data, unifying financial, clinical, operational and behavioural data to empower our customers with insights that highlight opportunities to deliver better value and care outcomes.
Our Vision and Ambition
To build the leading healthcare AI and platform services company in Asia that transforms the delivery of health and wellness for patients and communities by combining and leveraging the distinctive and complementary assets and strengths of AIA and Discovery.
Amplify Health will simplify access to health data and AI Innovation to accelerate distinct and disruptive healthcare value insights and resulting improvements in health outcomes through value-based care, personalised care plans and aligning individuals’ lifestyle/ behavioural choices.
By 2028, Amplify Health will have in place one of Asia’s strongest health-tech and AI capabilities; a comprehensive, integrated health technology stack supported by precision insights derived from proprietary data pools.
The Position
Summary
Based in India and reporting to the Claims Operations Lead, the Claims Operations Specialist is responsible for implementing Amplify Health’s in‑market strategy for claims operations solutions.
The role serves as a critical interface between client relationships, external stakeholders, including providers and regulators, and internal stakeholders to align transformation efforts with industry standards and requirements.
Key to success in this role will be the ability act the key conduit between the numerous business stakeholders and technical teams to translate complex business needs into actionable operational, process, and technology solutions for clients.
As Claims Operations Specialist, India, at Amplify Health you will play a key role in shaping the future of India’s claims management process. You will be working with some of the largest healthcare payors in the country, as well as providers and regulators to leave a lasting impact on the industry.
Responsibilities
Strategy Development & Execution
- Partner with the Claims Operations Lead to develop and implement an in‑market strategy that drives end‑to‑end transformation of claims operations and claims risk management.
- Identify opportunities to enhance operational efficiency through organisational redesign, process optimisation, automation, and technology adoption.
- Drive initiatives to increase straight-through processing (STP), reduce manual effort, and enhance adjudication accuracy.
- Track key KPIs to measure value realisation and operational effectiveness.
Technology and Innovation:
- Collaborate with AH’s product teams to design and deploy AH solutions.
- Collaborate with the client’s technology/data teams to ensure deployment of technology/data solutions are aligned with operational needs and changes to optimize the value in delivery.
- Work closely with technology teams to deploy AI-driven solutions for fraud detection, waste minimization, and claims adjudication.
- Oversee the integration of advanced analytics tools and predictive models to streamline claims workflows.
- Evaluate emerging technologies and partner with insurtech vendors to stay at the forefront of industry innovation.
Process Optimisation
- Lead transformation of end‑to‑end claims processes with a focus on cost and operational efficiency.
- Implement best‑practice frameworks for quality assurance, compliance, and medical claims management.
- Develop, monitor, and continuously refine KPIs to support improvement cycles.
Stakeholder Engagement
- Serve as a key liaison between underwriting, actuarial, provider management, technology, and customer service teams, to ensure seamless claims operations.
- Translate complex business requirements into actionable technical and operational specifications.
- Engage with regulators and providers to ensure alignment with industry standards and evolving regulatory expectations.
- Collaborate with client stakeholders to adapt processes and SOPs, ensuring alignment with local regulations and operational needs.
Change Management
- Lead organisational change efforts to foster a culture of innovation and adaptability within the claims team.
- Provide training and support to ensure smooth adoption of new processes and technologies.
- Communicate transformation goals, progress, and outcomes to leadership and other key stakeholders.
- Identify and close operational gaps through workflow observation, root cause analysis, and process improvement initiatives.
Fraud, Waste, and Abuse (FWA) Management
- Deploy advanced analytical and AI-enabled solutions to detect, prevent, and mitigate FWA.
- Collaborate with Special Investigation Units and analytics teams to continuously refine detection models.
- Recommend enhancements to audit frameworks and oversee tracking of value delivery.
Provider Risk Management
- Partner with provider management and claims teams to design and embed solutions that operationalise provider agreements.
- Translate provider requirements into SOPs, system rules, and workflow enhancements across pre‑auth, adjudication, IGL/FGL, and claims processing.
- Conduct workflow observations to identify opportunities to strengthen provider risk mitigation and value capture.
Candidate Profile
Experience and Qualifications
- Over 7 years of experience in provider management, clinical operations, medical claims, healthcare insurance, or related fields.
- Demonstrated experience leading claims transformation, operations improvement, or provider-management change initiatives.
- Strong background in leveraging automation, analytics, and AI within claims workflows.
- Familiarity with claims adjudication platforms, FWA detection tools, and data-driven operations design.
- Prior experience in consulting (strategy, operations, health systems) preferred.
- Medical degree (MD/MBBS) required; MBA or advanced degree preferred.
Competencies & Core Characteristics:
We are seeking a leader who embodies the following competencies and characteristics essential for success in our scale-up environment:
- Technical Domain Expertise: Demonstrates deep understanding of medical claims operations, provider risk frameworks, and healthcare insurance processes. Applies technical knowledge to design scalable, compliant, and high‑quality solutions. Ensures decisions are grounded in clinical, operational, and regulatory accuracy.
- Strategic Architect: Thinks systematically and anticipates long-term implications when designing policies, processes, and solutions. Develops clear strategic pathways that align operational execution with Amplify Health’s broader business objectives.
- Unifier & Cross-Functional Influencer: Builds strong relationships across product, technology, actuarial, commercial, and provider teams. Facilitates alignment among diverse stakeholders and drives consensus in complex, multi-party environments.
- Coach & Talent Multiplier: Elevates team capability by mentoring colleagues, sharing best practices, and enabling continuous learning. Cultivates a high-performance culture grounded in accountability and collaboration.
- Data-Driven Decisiveness: Applies analytical rigor to interpret trends, diagnose root causes, and drive evidence-based decisions. Uses KPIs, models, and performance dashboards to guide priorities and measure outcomes.
- Resilient Operator: Performs effectively in high‑ambiguity, fast‑paced environments. Adapts rapidly to evolving client needs, market dynamics, and organisational shifts while maintaining clarity and execution focus.
- Customer-Obsessed Advocate: Prioritises customer impact in all decisions. Builds trusted relationships with clients, understands operational pain points, and champions solutions that deliver measurable, sustainable value.
- Insatiable Curiosity: Constantly seeks new insights, innovations, and industry best practices. Demonstrates a growth mindset and embraces emerging technologies, methodologies, and ideas to elevate outcomes.
Join Us
If you are passionate about leveraging data to drive healthier outcomes across Asia and thrive in a dynamic, mission-driven environment, we encourage you to apply.
Amplify Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.
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