Reported successfully

Responsible for overseeing medical-related operational activities, including medical case review, service coordination, external service-provider oversight, and customer experience. Ensures smooth service delivery, compliance with operational standards, and alignment with the Company’s service objectives for policyowners with health-related benefits. Medical Operations Management

• Oversee operational processes related to medical benefits, including case handling, communication, and service quality. 
• Coordinate with internal teams and external service partners to ensure efficient service delivery. 
• Ensure adherence to operational guidelines, service standards, and regulatory requirements.

External Service Partner Oversight

• Act as the key operational liaison with third-party service partners. 
• Monitor partner performance metrics such as accuracy, turnaround time, and service quality. 
• Support issue resolution and continuous service improvement.

Medical Case Oversight

• Review complex or escalated medical cases and provide operational guidance. 
• Ensure case outcomes comply with policy terms and guidelines. 
• Endorse cases within delegated authority.

Customer Experience Management

• Oversee customer interactions related to medical benefits and servicing inquiries. 
• Ensure clarity, accuracy, and consistency of customer communication. 
• Manage escalated customer cases and resolutions professionally.

Governance, Process & Compliance

• Maintain and improve SOPs, workflows, and service protocols within medical operations. 
• Ensure alignment with regulatory guidelines, audit recommendations, and internal controls. 
• Conduct periodic checks on service quality and compliance adherence.

Reporting & Insights

• Prepare operational dashboards and reports related to medical service performance. 
• Analyze case trends and patterns to support internal decision-making. 
• Provide insights for service quality enhancement. 

• Bachelor’s degree in medicine, Nursing, Pharmacy, Health Sciences, or related field. 
• 5–7 years of experience in medical operations, medical case management, or health insurance administration. 
• Strong clinical interpretation and medical terminology knowledge. 
• Experience with third-party vendor/TPA management preferred. 
• Strong analytical, decision-making, and stakeholder management skills. 
• Excellent communication skills in Khmer & English.