Engineer – Rules Library
Skills
About This Role
Job Description
To lead and drive the Claims Management & PA’s Rules Library & Insights CoE agenda by enabling data-driven decision-making, improving operational performance, and embedding a culture of continuous improvement across Claims and Preauthorization.
The role translates business priorities into actionable insights and structured initiatives that enhance efficiency, quality, and decision consistency.
It also oversees the governance and continuous refinement of business rules and decision logics, ensuring alignment with clinical guidelines, policy frameworks, and regulatory requirements (e.g., Insurance Authority).
Acting as a key business partner, the role ensures standardization, transparency, and sustainable impact across operations while supporting improved member experience and cost optimization.
Insights & Performance Enablement
- Analyze performance trends, develop dashboards, and generate actionable insights for stakeholders
- Drive innovative initiatives to enhance efficiency and consistency of operations
- Identify improvement opportunities, lead structured initiatives, and embed best practices across functions
- Ensure effective governance and standardization of business rules and decision logics
- Define, review, and continuously refine rules in alignment with clinical guidelines, policy frameworks, and regulatory requirements (e.g., Insurance Authority)
- Act as a strategic partner to business and functional leadership
- Align on priorities, communicate insights, and support decision-making through structured engagement
Skills
- Bachelor’s degree in Industrial Engineering, MIS, Business Administrators or related fields
- 8+ years of experience in leadership role
- Experience in driving transformation or innovation initiatives within operations
- Holding Project Management Professional (PMP) or similar certifications
Technical
- Strong analytical and data interpretation skills
- Experience in performance management and KPI tracking (e.g., TAT, FTD, quality)
- Knowledge of healthcare policies, clinical guidelines, and insurance frameworks
- Ability to translate business challenges into structured insights and improvement initiatives
- Familiarity with reporting and visualization tools (e.g., Power BI, Excel, Cognos or similar)
Managerial
- Strategic thinking and problem-solving
- Stakeholder management and cross-functional collaboration
- Leadership and team development
- Change management and continuous improvement
- Strong communication and influencing skills
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