Claim Analyst

Manulife Insurance Malaysia; Jakarta Pusat; Hybrid; IDR 66,960,000 - 100,440,000; Full time

Benefits offered by this job

Hybrid work arrangement

Global team exposure

Job summary

Manulife is seeking a health insurance claims specialist to review and assess claims for members and providers. You will verify documents, determine outcomes, and liaise with hospitals and policyholders to resolve issues.

The role requires a healthcare degree and experience in claims/managed care, with strong analytical skills and Excel proficiency. A contract employment arrangement is offered within a hybrid working environment.

Qualifications

• Bachelor's degree in Medicine, Nursing, or a related healthcare field.
• Experience in health insurance claims, managed care, TPA, or health insurance operations is preferred.
• Strong understanding of medical terminology, health insurance benefits, and claims adjudication processes.
• Excellent analytical and investigative skills with strong attention to detail.
• Proficient in Microsoft Office, particularly Excel.
• Self-motivated, collaborative, and proactive in driving outcomes.
• Willing to work under a contract employment arrangement.

Responsibilities

• Review and assess health insurance claims submitted by members and healthcare providers.
• Verify the completeness and accuracy of supporting documents, including medical diagnoses, treatment records, investigation results, and medical expenses.
• Validate policy eligibility, benefits, coverage limits, exclusions, and applicable terms before making claim decisions.
• Determine claim outcomes, including approval, rejection, partial approval, or requests for additional information.
• Identify potential fraud, abuse, or irregular claim activities and esc
• Liaise with hospitals, clinics, healthcare providers, brokers, and policyholders to obtain additional information and resolve claim issues.
• Ensure claims are processed within the company's established Service Level Agreements (SLAs).
• Communicate claim decisions professionally and clearly to internal and external stakeholders.
• Ensure compliance with company policies, regulatory requirements, and governance standards.

Skills

Analytical skills

Attention to detail

Microsoft Excel

Communication

Team collaboration

Self-motivated

Education

Bachelor's degree in Medicine/Nursing or related healthcare field

Tools

Microsoft Office

Job description

Position Responsibilities

• Review and assess health insurance claims submitted by members and healthcare providers.
• Verify the completeness and accuracy of supporting documents, including medical diagnoses, treatment records, investigation results, and medical expenses.
• Validate policy eligibility, benefits, coverage limits, exclusions, and applicable terms before making claim decisions.
• Determine claim outcomes, including approval, rejection, partial approval, or requests for additional information.
• Identify potential fraud, abuse, or irregular claim activities and esc
• Liaise with hospitals, clinics, healthcare providers, brokers, and policyholders to obtain additional information and resolve claim issues.
• Ensure claims are processed within the company's established Service Level Agreements (SLAs).
• Communicate claim decisions professionally and clearly to internal and external stakeholders.
• Ensure compliance with company policies, regulatory requirements, and governance standards.

Required Qualifications

• Bachelor's degree in Medicine, Nursing, or a related healthcare field.
• Experience in health insurance claims, managed care, TPA, or health insurance operations is preferred.
• Strong understanding of medical terminology, health insurance benefits, and claims adjudication processes.
• Excellent analytical and investigative skills with strong attention to detail.
• Proficient in Microsoft Office, particularly Excel.
• Self-motivated, collaborative, and proactive in driving outcomes.
• Willing to work under a contract employment arrangement.

Preferred Qualifications

• Strong communication, coordination, and stakeholder management skills

When you join our team

We’ll empower you to learn and grow the career you want.

We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.

As part of our global team, we’ll support you in shaping the future you want to see.

Joining us means you’ll be empowered to learn and grow your career.

We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.

And as part of our global team, you’ll help shape the future you want to see – and discover that better can take you anywhere you want to go.

We’re proud of our accomplishments and recognitions.

About Manulife and John Hancock

Manulife Financial Corporation is a leading international financial services provider, helping people make their decisions easier and lives better.

To learn more about us, visit https://www.manulife.com/en/about/our-story.html.

Manulife is an Equal Opportunity Employer At Manulife/John Hancock, we embrace our diversity.

We strive to attract, develop and retain a workforce that is as diverse as the customers we serve and to foster an inclusive work environment that embraces the strength of cultures and individuals.

We are committed to fair recruitment, retention, advancement and compensation, and we administer all of our practices and programs without discrimination on the basis of race, ancestry, place of origin, colour, ethnic origin, citizenship, religion or religious beliefs, creed, sex (including pregnancy and pregnancy-related conditions), sexual orientation, genetic characteristics, veteran status, gender identity, gender expression, age, marital status, family status, disability, or any other ground protected by applicable law.

It is our priority to remove barriers to provide equal access to employment.

A Human Resources representative will work with applicants who request a reasonable accommodation during the application process.

All information shared during the accommodation request process will be stored and used in a manner that is consistent with applicable laws and Manulife/John Hancock policies.

To request a reasonable accommodation in the application process, contact [e-mail].

Working Arrangement Hybrid

We’re Manulife. And we’re on a mission to make decisions easier and lives better.

Better is what drives us.

It’s what inspired us to find new ways to support customers and colleagues in living longer and healthier lives.

It’s the reason we’re dedicated to investing in digital innovation and accelerating a sustainable and economically inclusive future.

Joining us means you’ll be empowered to learn and grow your career.

We’ll recognize and support you in a flexible environment where well-being and inclusion are more than just words.

And as part of our global team, you’ll help shape the future you want to see – and discover that better can take you anywhere you want to go.

We’re proud of our accomplishments and recognitions.

Recent awards include: 2024 Gallup Exceptional Workplace Award Winner Manulife Named one of Forbes World’s Best Employers 2023 Best Companies to Work for in Asia 2023 We’ve been recognized as one of Canada’s Top 100 Employers (2024) Manulife included in Bloomberg’s 2023 Gender-Equality Index