قائد تحول الأنظمة الأساسية للتأمين الطبي

Job Requisition ID: 177489

Established in the 1930s as a trading business, Al-Futtaim Group today is one of the most diversified and progressive, privately held regional businesses headquartered in Dubai, United A”rab Emirates. Structured into five operating divisions; automotive, financial services, real estate, retail and healthcare; employing more than 35,000 employees across more than 20 countries in the Middle East, Asia and Africa, Al-Futtaim Group partners with over 200 of the world's most admired and innovative brands. Al-Futtaim Group’s entrepreneurship and relentless customer focus enables the organisation to continue to grow and expand; responding to the changing needs of our customers within the societies in which we operate.

By upholding our values of respect, excellence, collaboration and integrity; Al-Futtaim Group continues to enrich the lives and aspirations of our customers each and every day.

Job Description:

The Medical Core System Transformation Lead is responsible for end‑to‑end delivery of the health insurer’s core medical system modernization, including policy administration, claims, benefits, provider management, and clinical integrations.

This role owns the business-led transformation of legacy medical systems into a modern, scalable, compliant, and digital-first platform that enables operational efficiency, better member and provider experience, regulatory compliance, and future AI/analytics capabilities.

What you will do

1. Transformation Leadership

• Lead the strategy, design, and execution of the medical core system transformation program.
• Act as the single point of accountability for business outcomes, timeline, and value realization.
• Translate enterprise strategy into a clear transformation roadmap (phased migration, MVPs, decommissioning).

2. Core Medical Systems Ownership

• Own transformation across key medical domains, including:
• Claims adjudication and payment
• Policy & benefits configuration
• Provider and network management
• Authorizations and utilization management
• Medical pricing, rules, and payment logic
• Drive modernization from monolithic/legacy platforms to configurable, API-driven core solutions.

3. Business & Clinical Alignment

• Partner with Medical, Operations, Finance, Actuarial, Compliance, and Provider Relations teams.
• Ensure business rules, clinical workflows, and regulatory requirements are accurately digitized.
• Resolve trade-offs between standard product capability vs. local customization.

4. Vendor & Partner Management

• Lead engagement with core system vendors, system integrators, and niche solution providers.
• Oversee solution design, deployment quality, and contractual commitments.
• Govern vendor delivery to ensure alignment with architecture, security, and compliance standards.

5. Governance & Delivery Execution

• Establish strong program governance, including milestones, dependencies, and risks.
• Manage multi-workstream delivery (technology, data, business readiness, migration, change).
• Ensure transformation is delivered with minimal disruption to ongoing business operations.

6. Regulatory & Compliance Readiness

• Ensure core systems meet health insurance regulatory, payer, and data privacy requirements.
• Support audits, reporting, and compliance validation through system design and controls.

7. Change, Adoption & Value Realization

• Drive business adoption through process redesign, training, and change management.
• Define and track value realization metrics (speed, cost, accuracy, scalability).
• Enable future capabilities such as analytics, automation, and AI-driven operations.

Required Skills to be successful

Essential Experience

• 12+ years of experience in health insurance, payer operations, or healthcare technology.
• Proven leadership of large-scale core system transformation programs in medical insurance.
• Deep understanding of medical claims, benefits, pricing, provider networks, and utilization management.
• Experience modernizing legacy medical core platforms to modern or SaaS-based solutions.

Technical & Domain Expertise

• Strong knowledge of health insurance core systems (claims/PAS/medical modules).
• Experience with system migration, data conversion, and parallel run strategies.
• Understanding of API-based integration, interoperability, and data architecture.
• Comfort working with enterprise architects, security, and data teams.

Leadership & Ways of Working

• Strong stakeholder management across business, clinical, technology, and vendors.
• Ability to lead through ambiguity and make pragmatic trade-offs.
• Executive-level communication and decision facilitation skills.
• Outcome-oriented mindset with strong delivery discipline.

What equips you for the role

• Core medical system migration delivered on time and within agreed scope.
• Reduction in claims processing time, errors, and manual interventions.
• Improved configurability of medical benefits and pricing.
• Measurable improvement in member and provider experience.
• Safe decommissioning of legacy platforms and technical debt reduction

About Orient Insurance PJSC

Orient Insurance Company commenced operations in 1982 as a part of the reputed Al-Futtaim Group and has since recorded a progressively steady growth. The Company is counted among the leaders in the UAE insurance market. Orient Insurance Company has a paid-up capital of AED 500 Million which is the highest in the insurance industry in UAE. With head office in Dubai, the company serves its clientele through an extensive branch network in Jebel Ali, Abu Dhabi, Al Ain, Sharjah and Ras Al Khaimah in UAE, Muscat in Sultanate of Oman, Riyadh in Kingdom of Saudi Arabia and Bahrain.