Senior TPA Medical Operations & Digital Transformation Officer

About the role

Ascoma Insurance Advisor & Broker, part of Chedid Capital Group, is looking for a Senior TPA Medical Operations & Digital Transformation Officer. The role monitors and improves the operational performance of the Group's TPA Santé subsidiaries, oversees digital transformation initiatives and ensures the quality, efficiency and standardisation of medical insurance processes across the Group.

Key responsibilities

• Monitor and assess operational processes across the full TPA Santé cycle, including policy administration, claims, pre-authorisations, billing, payments, provider management and fraud prevention.
• Ensure compliance with Group procedures, internal control requirements and Internal Audit recommendations.
• Monitor transaction quality and data accuracy, identify discrepancies and coordinate corrective actions with subsidiaries.
• Oversee digital transformation projects, improving productivity, service quality, efficiency and cost control.
• Review and optimise processes, recommend reengineering and ensure standardisation of operational practices.
• Track performance through KPIs such as productivity and quality control indicators.
• Coordinate with subsidiaries, follow up on action plans and lead operational governance meetings.
• Take part in system testing, monitor technical issues and coordinate the deployment and stabilisation of new digital solutions.
• Contribute to the Group's medical reference framework and the integration of AI solutions into healthcare processes.
• Support Agile methodologies, train subsidiary staff and help update Group operational procedures and manuals.
• Support mandatory health insurance schemes and complementary insurance processes.

Required profile

• Doctor of Medicine (MD) with clinical experience.
• Minimum 6 years of experience in health insurance, preferably in TPA operations.
• Experience in health insurance operations, digital transformation and process improvement, with knowledge of healthcare systems and performance monitoring.
• Fluency in French and English, written and spoken.
• Willingness to travel to African subsidiaries when required.