Navigos ★ 3.3

About the Role

Responsible for overseeing all aspects of customer management and insurance operations, including underwriting, policy servicing, customer service, claims management, and reinsurance. With a strong focus on health insurance and digital distribution, the CCOO ensures operational excellence, superior customer experience, and effective risk management. The role drives process efficiency, operational scalability, and customer-centric innovation to support business growth and profitability.

Responsibilities

Underwriting & Risk Assessment:

• Oversee underwriting operations to ensure accurate risk assessment, pricing, and portfolio profitability.
• Develop underwriting policies, guidelines, and automated tools for efficient decision-making.

Policy Administration & Customer Service:

• Ensure timely and accurate issuance, maintenance, and servicing of insurance policies.
• Drive high-quality customer service across all touchpoints, leveraging digital platforms for seamless customer experience.

Claims Management:

• Lead claims operations to ensure fair, efficient, and timely claims settlement.
• Implement processes to minimize fraudulent claims and optimize claims cost management.

Customer Experience Leadership:

• Design and implement a customer-centric operational model covering the full medical and insurance journey — from onboarding to claims and post-service engagement.

Claims and Case Management Excellence:

• Oversee the development and continuous improvement of claims, case, and care management frameworks to ensure fairness, accuracy, and speed.
• Establish data-driven monitoring and predictive tools to manage high-cost claims and optimize medical cost containment.

Provider and Hospital Network Management:

• Develop and maintain strategic partnerships with hospitals, clinics, and health service providers nationwide to ensure quality, efficiency, and accessibility.
• Negotiate and manage provider contracts and pricing frameworks to control loss ratios while maintaining service quality.

Fraud, Waste, and Abuse (FWA) Control:

• Implement robust fraud detection and prevention systems using analytics, AI, and machine learning to identify anomalies and ensure claim integrity.
• Lead investigations and collaborate with compliance and legal teams on fraud management protocols.

Digital Transformation and Process Optimization:

• Drive automation, self-service, and digital tools to enhance customer experience and operational efficiency.

Reinsurance Management:

• Oversee reinsurance strategies and treaties to optimize risk transfer and protect the company’s solvency.
• Ensure compliance with regulatory requirements and effective monitoring of reinsurance partners.

Operational Excellence & Digital Enablement:

• Streamline and standardize processes across underwriting, policy service, claims, and reinsurance.
• Drive digital adoption and process automation to enhance operational efficiency and customer experience.

Leadership & Collaboration:

• Lead, mentor, and develop high-performing operations teams.
• Collaborate with peers in Distribution, Marketing, Finance, and Corporate Affairs to align operations with business strategy.

Qualifications

• Education: Bachelor’s degree in Insurance, Business Administration, Finance, or related fields.
• Advanced degree or professional certifications (ACII, CPCU) preferred.
• Minimum 15 years in health insurance operations or healthcare management, with at least 5 years in a senior leadership role at a leading insurer (AXA, Allianz, or equivalent).
• Deep understanding of medical networks, health claims management, cost containment, and customer service transformation.
• Proven track record in building provider partnerships, optimizing operational efficiency, and driving digital health transformation.
• Proven experience leading large operational teams and implementing process improvements or digital initiatives.
• Knowledge of digital distribution channels and customer-centric operations highly desirable.
• Strong leadership, creativity, and stakeholder management skills.
• Excellent English and Vietnamese communication skills (both written and spoken).