About AXA Hong Kong and Macau
AXA Hong Kong and Macau is a member of the AXA Group, a leading global insurer with presence in 50 markets and serving 95 million customers worldwide. Our purpose is to act for human progress by protecting what matters.
As one of the most diversified insurers in Hong Kong, we offer integrated solutions across Life, Health and General Insurance. We are the largest General Insurance provider and a major Health and Employee Benefits provider. Our aim is to not only be the insurer to provide comprehensive protection to our customers, but also a holistic partner to the individuals, businesses and community we serve. At the core of our service commitment is continuous product & service innovation and customer experience enrichment, which is achieved through actively listening to our customers' needs and leveraging and investing in technology and digital transformation.
We embrace our responsibility to be a driving force against climate change and a force for good to create shared value for our community. We are proud to be the first to address the importance of mental health through different products and services and thought leading iconic research. Our overall Sustainability Strategy, with emphasis on climate strategy and biodiversity commitment, is developed based on TCFD recommendations. We are committed to integrating environmental, social and governance factors across our business and strive to contribute to a sustainable future through 3 distinct roles - as an investor, an insurer and an exemplary company.
AXA is an equal opportunity employer. We are committed to promoting Diversity and Inclusion (D&I) by creating a work environment where all employees are treated with dignity, respect, and where individual differences are valued. We welcome and treasure diverse profiles to join our big family, and to build an inclusive culture together which allows everyone to maximise their personal potential.
Our people strategies are designed to enhance employee well-being and professional growth, ultimately empowering them to excel within the company. Click here to learn more about our Benefits (https://www.axa.com.hk/en/benefits) , Culture (https://www.axa.com.hk/en/culture-and-values), & Career Development (https://www.axa.com.hk/en/career-development).
Responsibilities:
1. Clinical Governance & Provider Audit
- Develop and implement clinical governance frameworks to ensure adherence to quality standards
- Lead provider audits to assess compliance with clinical protocols, documentation accuracy, and care outcomes.
- Collaborate with providers to address gaps and implement corrective action plans.
2. Data-Driven Cost Control & Analytics
- Utilize advanced analytics (SQL, Power BI, Tableau) to monitor healthcare utilization, cost trends, and risk metrics.
- Identify cost-saving opportunities through data insights (e.g., high-cost claimants, preventable admissions).
- Track KPIs for cost efficiency, provider performance, and population health via dashboards and performance reports
3. Provider Network Performance
- Manage provider relationships to ensure alignment with clinical and financial goals.
- Analyze provider performance data (e.g., efficiency, quality scores) for network optimization.
- Negotiate performance-based contracts with providers focused on value-based care.
4. Medical Concierge & Case Management
- Oversee medical concierge services for high-touch patient navigation and care coordination.
- Optimize care pathways, reduce hospital readmissions, and support complex cases.
- Integrate patient data to personalize care plans and interventions.
- Align case management plans with pre-auth protocols for seamless care continuity.
- Implement patient steering strategies to direct members toward high-quality, cost-effective providers.
6. Clinical/ medical Preauthorization
- Ability to handle preauthorization on medical/ clinical procedures and or medical investigations and medications prescriptions in a professional and efficient manner
- Ensure pre-auth decisions enforce reasonable and customary cost benchmarks and contractually agreed rates.
- Analyze pre-auth data to pinpoint high-cost drivers, wasteful services, and outlier provider practices; develop action plans to address.
- Collaborate closely with claims, Network Management, FWA committee to report suspicious patterns and recover costs.
Qualifications:
- Fluency in written and spoken English & Cantonese
- At least 5 years of experience of working in medical disciplines is required
- University graduate from medical/ healthcare field with Strong knowledge on medical and clinical procedures
- License Registered Nurse is strongly preferred
- Background in healthcare insurance market or healthcare provider market or relevant transferable skills and knowledge
- Able to carry out effective coaching and training
- Good communication and negotiation skill
- Good problem solving and decision-making skills
- Demonstrate ability to deal with difficult people
- Experience in project implementation
- High levels of integrity and trust
