Functional Lead (Insurance Claims)

Company : Cognizant

Job Type : Full Time

Hong Kong

Number of Applicants

000+

Let AI Supercharge Your Job Hunt!

JobCopilot scans 500,000+ company career sites daily to find jobs for you

Never miss an opportunity Save hours by auto-filling applications forms Land more interviews with tailored applications

Activate JobCopilot

Job Description - Functional Lead (Insurance Claims)

Key Responsibilities

Serve as the company's functional lead for claims during all phases of the implementation.
Act as the functional anchor for all claims-related requirements, workshops, and design validations-working directly with the customer and representing the company's product with domain authority.
Conduct and lead requirement workshops, including discovery, process validation, and data mapping sessions.
Lead workshops with confidence, validate use cases, map requirements, and guide the customer through best practices-avoiding vague elicitation.
Understand Hong Kong's health claims landscape-including:
- VHIS products and top-up riders
- Pre-authorisation flows and provider billing logic
- Medical coding standards (ICD, PCS, TOSP)
- Provider networks and reimbursement models
- Claims SLAs, appeals, regulatory workflows, and audit readiness
Provide clear, assertive guidance to customers-mapping their needs to the company's product capabilities and identifying any configuration/localisation required.
Act as a bridge between the customer's business team and the company's offshore implementation and product teams (India-based).
Support test scenario definition, UAT planning, and go-live validation, ensuring alignment to the functional use cases.
Review product enhancements or localisation requests to ensure they are truly needed and not a workaround for missing understanding.
Document all validated requirements in collaboration with Business Analysts and maintain traceability.

Required Skills & Experience

10+ years of experience in the health insurance claims domain.
Deep understanding of end-to-end health insurance claims processing in Hong Kong, including:
- Pre-authorisation
- Provider management
- ICD/PCS codes
- Adjudication rules
- Regulatory expectations
Strong domain knowledge across claims processing, provider management, benefit adjudication, and regulatory compliance.
Prior experience working on claims platform implementations or transformation projects in Hong Kong or other APAC health insurance markets.
Familiarity with:
- ICD, PCS, and surgical procedure codes
- Medical necessity and coding validation
- Claim-to-policy benefit mapping
- Eligibility verification and co-pay/deductible logic
Ability to lead workshops, navigate ambiguity, and guide business users confidently.
Excellent communication skills in English; Cantonese proficiency is preferred but not mandatory.
Ability to interact closely with Hong Kong-based business users and health claims teams.
Ability to work with offshore teams and represent the product roadmap, configurability, and functional boundaries clearly.

Preferred Qualifications

Experience working with Hong Kong-based life and health insurers.
Functional experience with auto-adjudication engines, pre-auth platforms, or provider portals.
Exposure to regulatory guidelines from FHB, IA, or MOH in Hong Kong.
Clinical coding background or familiarity with coding audit processes is a strong plus.
Bachelor's degree in Life Sciences, Insurance, Healthcare Administration, or equivalent.

Original job Functional Lead (Insurance Claims) posted on GrabJobs ©. To flag any issues with this job please use the Report Job button on GrabJobs.

Auto-Apply to Similar Jobs

Share Job

Get your Resume Reviewed for Free

Automate Job Applications for Similar Jobs

Auto-Apply to Functional Lead Jobs with your AI JobCopilot

Auto-Apply with AI

Similar Functional Lead Jobs in Hong Kong

Get your Resume Reviewed for Free

Email address

Why are you reporting this job?

I think it’s a discriminatory or offensive

I think it’s fraudulent or a scam

I think it’s trying to sell something unrelated to the job / it’s asking for money

I think it contains incorrect or broken information

Other

All Job Ads are subject to GrabJobs’s Terms of Service. We allow users to flag postings that may be in violation of those terms. Job Ads may also be flagged by GrabJobs moderation team. However, no moderation system is perfect, and flagging a posting does not ensure that it will be removed.

Setup your job alert:

Frequency

By activating job alerts, I agree to GrabJobs Terms & Privacy Policy. I can unsubscribe to job alerts anytime. Skip

Functional Lead (Insurance Claims)

Job Description - Functional Lead (Insurance Claims)

Similar Functional Lead Jobs in Hong Kong

Mobile Apps