AI-Driven Health Insurance Claim Analyst

PT Vertika Technologies Nusantara; Jakarta Pusat; On-site; IDR 78,120,000 - 122,760,000; Full time

Job summary

Rey.id, a technology-driven health and life insurance provider in Indonesia, seeks a Claim Analyst. You will review and verify claim documents, classify them by claim type and service, and identify incomplete or invalid submissions.

You will validate AI-generated claim analysis with supporting documents, ensure the accuracy of diagnosis, cost, and service date, and prepare claim reports while maintaining confidentiality of member data.

Qualifications

• Diploma/Bachelor’s in Nursing, Midwifery, Public Health, or related medical background.
• Minimum 2 years of experience in a Health Insurance company.
• Experience as a Claim Analyst in an insurance company is a plus.

Responsibilities

• Review and verify claim documents, classify by type and services, identify incomplete/invalid submissions.
• Validate AI-generated claim analysis with supporting documents; ensure accuracy of diagnosis, cost, and service date.
• Identify discrepancies, incomplete documents, or potential fraud cases.
• Ensure claim processing complies with SOP and SLA.
• Prepare and maintain claim reports and documentation.
• Provide accurate claim-related information and support member inquiries.
• Maintain confidentiality of member data and personal information.

Skills

Analytical thinking

Problem solving

Detail oriented

Communication skills

Education

Nursing / Public Health degree

Tools

AI-assisted systems

Job description

Rey.id, a technology-driven health and life insurance provider in Indonesia, seeks a Claim Analyst. You will review and verify claim documents, classify them by claim type and service, and identify incomplete or invalid submissions.

You will validate AI-generated claim analysis with supporting documents, ensure the accuracy of diagnosis, cost, and service date, and prepare claim reports while maintaining confidentiality of member data.