Claim Analyst

AIA Hong Kong; Daerah Khusus Ibukota Jakarta; On-site; IDR 200.000.000 - 300.000.000; Full time

Job summary

A leading health insurance company in Jakarta is looking for a Medical Claims Manager to provide technical expertise and manage healthcare services for policy holders. The ideal candidate has a Bachelor's degree in medicine, at least 5 years of experience in the health insurance industry, and strong communication and leadership skills. This role offers opportunities for significant career growth and the chance to contribute to community health improvements.

Qualifications

• Minimum 5 years of relevant experience in the life or health insurance industry.
• Able to work in a fast-paced environment.
• Good English communication skills, both written and verbal.

Responsibilities

• Ensure the claim process at TPA is valid as per policy provisions.
• Analyze TPA cashless claims.
• Monitor cashless performance and create solutions for improvements.
• Respond to enquiries regarding claim payments.

Skills

Claim process management

Healthcare knowledge

Communication skills

Leadership skills

Decision-making skills

Education

Bachelor's degree in medicine

Job description

At AIA we’ve started an exciting movement to create a healthier, more sustainable future for everyone.

It’s about finding new ways to not only better people's lives, but to better the communities and environments we live in. Encompassing our ambition of helping a billion people live Healthier, Longer, Better Lives by 2030.

And to get there, we need ambitious people who believe in playing an important part in shaping that future. People seeking unmatched career and personal growth opportunities, who are driven to work with, and learn from some of the most inspiring and supportive leaders in the business.

Sound like you? Then read on.

About the Role

Responsible for providing technical medical expertise for decisions and resolution of customer enquiries and claims and managing healthcare related services provided to policy holders.

Main responsibilities:

• Ensure claim process at TPA have good quality and valid as our policy provision
• Analyze TPA cashless claim
• Secondary layer review case amount >20 million before creating CDV
• Monitoring cashless performance at TPA by creating solution to minimize repetitive error or any delayed process
• Minimize complaint and increase customer satisfaction
• Cooperate with Underwriting Dept related cases with PEC/NDC that's found at TPA claim process
• Respond any enquiry from provider related claim payment by AIA

Ad hoc:

• Report NDC finding for re-underwriting review
• Meeting with customer

Job Requirements:

• Bachelor's degree with medical doctor (must)
• Minimum 5 years of relevant experience in life or health insurance industry
• Have a good knowledge in system, claim process, insurance principal and AIA policy provision
• Able to work in a fast-paced environment
• Good communication skill; english written and verbal skill is preferable
• Good leadership and decision-making skill

Build a career with us as we help our customers and the community live Healthier, Longer, Better Lives.

You must provide all requested information, including Personal Data, to be considered for this career opportunity. Failure to provide such information may influence the processing and outcome of your application. You are responsible for ensuring that the information you submit is accurate and up-to-date.