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 is a technology-driven health and life insurance provider in Indonesia, offering a holistic approach to healthcare services and well-being. Unlike traditional insurance products, Rey focuses on quality healthcare services to improve the lives of its members. The company is committed to reimagining and democratizing life and health insurance to make it more desirable and beneficial.

Job Description:

Review and verify claim documents to ensure completeness and accuracy such as verify and ensure completeness of claim documents, classify claim documents based on claim type and services, and identify incomplete or invalid documents and elevate when needed

Validate AI-generated claim analysis results with supporting documents, from review and validate AI-generated claim analysis results, ensure accuracy of claim data such as 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

Requirement:

Minimum Diploma/Bachelor’s degree 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 would be an advantage

Strong analytical thinking and problem-solving skills

Detail-oriented with high accuracy in handling data and documents

Familiar with claim verification and healthcare documentation

Adaptable, quick learner, and comfortable working with technology/AI-assisted systems

Proactive, initiative-driven, and able to work independently as well as collaboratively

Good communication skills in handling internal coordination and member inquiries

Beyond what is offered by traditional insurers, Rey leverages its proprietary technology platform to deliver insurance with a hassle-free experience, integrated with a digital healthcare & wellness ecosystem. Hence in the immediate future, one of our focuses is to implement EHR to capture 360-degrees of members' data (both health and activities) - which will be used for multiple analytics linked back to the insurance side.

Beyond what is offered by traditional insurers, Rey leverages its proprietary technology platform to deliver insurance with a hassle-free experience, integrated with a digital healthcare & wellness ecosystem. Hence in the immediate future, one of our focuses is to implement EHR to capture 360-degrees of members' data (both health and activities) - which will be used for multiple analytics linked back to the insurance side.