Healthcare Jobs in Hong Kong Island, China (Now Hiring) — 19 open

We are seeking an experienced claims professional to lead the design and optimisation of adjudication frameworks and medical‑necessity controls to strengthen payment integrity outcomes.

The position will provide strategic leadership on claims adjudication policies, medical‑necessity controls, and decision frameworks to strengthen payment integrity outcomes. The role will be isolated from day‑to‑day claims processing with focuses on design, optimisation, and governance of adjudication logic.

Key Responsibilities

1. Adjudication Strategy & Control Design
• Design and strengthen medical‑necessity‑based adjudication frameworks across priority benefits and pathways.
• Identify adjudication control gaps that drive claims leakage or inappropriate payments.
2. Policy & Rule Optimisation
• Translate clinical guidelines, benefit intent, and payment integrity objectives into adjudication rules and decision logic.
• Partner with analytics and systems teams to enable consistent and scalable implementation.
3. Cross‑Functional Clinical Alignment
• Collaborate with Medical Affairs, Benefits, and Claims stakeholders to align adjudication policies with care standards and utilisation strategies.
• Support alignment with Group‑level adjudication standards while addressing local regulatory requirements.
4. Performance & Governance Enablement
• Define adjudication‑related KPIs (e.g. medical‑necessity compliance, leakage reduction).
• Review outcomes and recommend enhancements to improve payment accuracy and consistency.

Qualifications & Experience

Required

• Bachelor’s degree in Healthcare, Insurance, Business or related field
• Clinical or insurance certifications preferred
• 8–12 years experience in claims adjudication or policy design
• Strong experience in health claims adjudication, medical necessity frameworks, or payment policy design
• Solid understanding of claims systems, adjudication logic, and healthcare benefits
• Ability to operate as a strategic advisor across clinical and operational teams

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 52 markets and serving 92 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 Inclusion and Diversity (I&D) 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).