About Amplify Health

Who We Are

Amplify Health Asia Pte. Limited (Amplify Health) is a pan-Asian health technology and analytics company which brings together health technology assets, proprietary data analytics and healthcare expertise to support innovation across the healthcare value chain.

Headquartered in Singapore, Amplify Health operates in 10 markets across the region: Australia, Hong Kong, India, Indonesia, Malaysia, New Zealand, the Philippines, Singapore, Thailand and Vietnam.

Amplify Health develops integrated solutions that empower healthcare payors, providers and policymakers across Asia to identify value and drive new partnerships, understand variation and address systemic inefficiencies—with the aim of improving outcomes for individuals and the sustainability of health systems.

Powered by a clinically enriched data foundation, Amplify Health’s health intelligence platform combines modular AI solutions, context-aware automation and deep regional insights to offer localised, AI-powered health solutions spanning health payment integrity to chronic disease management. The company’s technology has earned recognition at several industry competitions, including the Celent Model Insurer Awards, ITC Asia Awards and SBR Technology Excellence Awards.

As an ISO27001 certified organisation, Amplify Health maintains clearly defined policies, structured oversight mechanisms and ongoing risk assessments that ensure alignment with global best practices on enterprise data security.

Our Vision and Ambition To build the leading healthcare AI and platform services company in Asia that transforms the delivery of health and wellness for patients and communities by combining and leveraging the distinctive and complementary assets and strengths of AIA and Discovery.

Amplify Health will simplify access to health data and AI Innovation to accelerate distinct and disruptive healthcare value insights and resulting improvements in health outcomes through value-based care, personalised care plans and aligning individuals’ lifestyle/ behavioural choices.

By 2028, Amplify Health will have in place one of Asia’s strongest health-tech and AI capabilities; a comprehensive, integrated health technology stack supported by precision insights derived from proprietary data pools.

The Position

Summary

We are seeking a strategic and experienced healthcare leader to drive the creation, validation, and governance of clinical and operational rules targeting Fraud, Waste, and Abuse (FWA) in health insurance. This role also oversees benefit mapping activities related to provider contracts, policy exclusions, claims adjudication, pre-authorization, and underwriting. The ideal candidate will possess deep expertise in healthcare coding, regulatory compliance, and stakeholder engagement across APAC and international markets.

Responsibilities

1. Dual Clinical Streams Oversight

- FWA Rules Stream: Lead the design and maintenance of clinical and operational rules to detect and prevent FWA in claims processing.
- Benefit Mapping Stream:



Oversee the development and maintenance of benefit mapping frameworks that support:
- Provider contract interpretation
- Policy exclusions and inclusions
- Claims adjudication logic
- Pre-authorization criteria
- Underwriting workflows
- Schedule of benefits
- Billing rules

Stakeholder Engagement & Alignment

- Lead frequent engagement with internal stakeholders (e.g., product managers, data scientists, data analysts, medical coders etc.) to ensure alignment on rule logic, benefit definitions, and operational priorities.
- Collaborate with external stakeholders (e.g., clients, regulators, providers, industry bodies) to ensure expectations are met and standards are upheld.
- Facilitate workshops, working groups, and feedback loops to ensure shared understanding of requirements and continuous improvement.

FWA Research & Strategy

- Identify areas of high volume, high cost, and high risk across claims data to prioritize rule development and intervention strategies.
- Monitor and analyze international and APAC-specific FWA trends, regulatory updates, and industry best practices.
- Conduct in-depth research and extract rule logic, concepts, and methodologies from renowned international healthcare organizations and regulatory bodies, including those in the United States, Canada, Australia, and other leading jurisdictions.
- Collaborate with actuarial, data science, and clinical teams to ensure strategies are evidence-based and aligned with business objectives.

Code Value Sets & Reference Lists

- Lead the creation, validation, and ongoing maintenance of standardized code sets and reference lists for terminologies such as ICD, CPT, SNOMED CT, LOINC, ATC, and other relevant classification systems, for rules & benefits.
- Provide clinical and operational logic that underpins the use of these code sets, ensuring they are contextually accurate and aligned with clinical rules, benefit definitions, policy exclusions, and adjudication workflows.
- Review and critically assess the work of peers and collaborators, challenge assumptions, offering constructive feedback to refine outputs and close the loop on development cycles.
- Collaborate with data scientists & other clinical teams to ensure seamless integration of code sets into the database.

Leadership & Collaboration

- Develop SOPs, principles, guidelines, and workflows for the end-to-end lifecycle of clinical rules and benefit mappings—including their design, validation, implementation, monitoring, and continuous improvement, to ensure consistency, compliance, and operational efficiency across all touchpoints.
- Provide training and mentorship on FWA detection, benefit mapping,



and coding standards to internal & external stakeholders.
- Serve as a Subject Matter Expert to support other clinical teams by providing expert guidance, critical review, and actionable feedback, fostering collaboration and ensuring alignment with Clinical Informatics team strategic objectives.

Candidate Profile

Experience & Qualifications The following requirements are essential:

- Graduate Health Care qualification required, preferably medical degree with a minimum of 5 years of post-qualification experience.
- Master’s degree in Health Informatics, Clinical Sciences, Public Health, or Health Administration would be preferred.
- Private health care experience within Asia, or more globally, would be an advantage.
- 8+ years of experience in health insurance, clinical coding, or claims analytics, with at least 3 years in a leadership role.
- Deep knowledge of FWA typologies, healthcare billing practices, and regulatory frameworks.
- Proficiency in clinical terminologies and value set management tools (e.g., VSAC, UMLS, eCQM platforms).
- Strong stakeholder management and communication skills across clinical, operational, and regulatory domains.

Technical understanding A working understanding of the data used in healthcare is optimal as data forms the basis of our products, as such the following core understandings are required:

- Understanding of healthcare specific data
- Reasonable competence in use of Microsoft Office suite of tools especially Excel, Access and PowerPoint
- Knowledge of patient health management, provider profiling, healthcare reporting, and other key healthcare technologies, etc
- Detailed knowledge and working experience of clinical tools and international coding including groupers, crosswalks and classification systems

The following understandings are advantageous however not essential:
- SQL, python, and advanced excel
- Understanding of advanced statistics, risk adjustment and health outcome indices and metrics
- Knowledge of usage of data science in the healthcare space
- Experience in Microsoft Azure (Databricks, Synapse, Data Factory, etc.)

Behavioral skills

- Demonstrated ability to effectively lead and actively manage teams of experienced clinical, multidisciplinary experts in their fields
- Exceptional communication skills across a wide range of stakeholders
- Ability to work cohesively in a team setting while balancing multiple priorities
- High level of attention to detail, resilience, enthusiasm, energy and drive
- Positive, can-do attitude focused on continuous improvement
- Ability to take feedback and constructive criticism to drive improved delivery
- Rigorous ability to solve problems and optimize environment
- Excellent co-ordination skills

Join Us

If you are passionate about leveraging data to drive healthier outcomes across Asia and thrive in a dynamic, mission-driven environment, we encourage you to apply.

Amplify Health is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

📌 Senior Specialist-Clinical Rules & Benefits (Gurugram)
🏢 Amplify Health
📍 Gurugram