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

Cognizant - Hong Kong - Full time

Salary: Competitive

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.
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