Job Description

FIND YOUR 'BETTER' AT AIA

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.

If you believe in better, we’d love to hear from you.

About the Role

The Model Office Lead will be responsible for the operationalization of the target operating model for the Claims Function as part of the organization’s Claims Transformation Program. This leadership role will establish a new operational unit that integrates adjudication, automation, validation, audit, and fraud investigation capabilities. The position requires expertise in Claims Managemrent , should demonstrate understanding in Fraud, Waste, and Abuse (FWA) management, and a strong background in business process transformation. The role calls for a proven leader capable of building a high-performing and scalable operation, ideally with experience in managing shared services or outsourced environments. The Model Office Lead will shape the foundation of the organization’s next generation operating model, ensuring alignment with strategic objectives, quality standards, and regulatory expectations.

DUTIES & RESPONSIBILITIES

1. Model Office Establishment

• 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.

2. Organization Design and Workforce Enablement

• 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.

3. Operational Management and Performance Excellence

• 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.

4. Governance, Audit, and FWA Oversight

• 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.

5. Leadership and Change Management

• 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.

MediCard is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Join MediCard Now!

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

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