Claim Analyst Reimbursement Senior

White Glove Hiring; Jakarta Pusat; On-site; IDR 100,440,000 - 145,080,000; Part time

Job summary

PT Reycom Document Solusi (RDS) membuka lowongan untuk analis klaim kesehatan dengan fokus klaim rawat inap. Kandidat memiliki gelar Sarjana Keperawatan dan pengalaman minimal 3 tahun dalam klaim kesehatan.

Posisi ini menuntut kemampuan analitis, akurasi tinggi, serta kemampuan berkomunikasi efektif. Lokasi pekerjaan di East Jakarta, bekerja secara onsite dengan alam kerja kontrak.

Qualifications

• Memiliki kemampuan analitik yang kuat dan mampu memecahkan masalah secara efektif.
• Kemampuan komunikasi yang baik, baik lisan maupun tulisan.
• Ketekunan dan perhatian terhadap detail dalam evaluasi dokumen medis dan klaim.
• Dapat bekerja secara mandiri maupun dengan berbagai pemangku kepentingan.

Responsibilities

• Menganalisis dan memproses klaim reimbursement asuransi kesehatan untuk perawatan inap.
• Mereview dokumen medis, diagnosis, perawatan, dan dokumen klaim untuk menilai kelayakan dan akurasi.
• Memvalidasi klaim terhadap manfaat, cakupan, pengecualian, dan syarat ketentuan.
• Menangani klaim reimbursement untuk anggota korporat maupun individu.
• Mengelola kasus klaim kompleks, termasuk ketidaksesuaian dan potensi irregularitas.
• Berkolaborasi dengan anggota, PIC korporat, penyedia layanan kesehatan, agen, dan tim internal.
• Memastikan pemrosesan klaim tepat waktu sesuai SLA/TAT dan prosedur perusahaan.
• Mendukung proses billing klaim, pelaporan, dan dokumentasi.
• Mengidentifikasi peluang perbaikan proses klaim dan memberikan rekomendasi.

Skills

Analytical

Problem solving

Communication

Attention to detail

Education

Bachelor's degree in Nursing

Job description

DESKRIPSI PEKERJAAN

Job Description:

• Analyze and process health insurance reimbursement claims, primarily inpatient claims.

• Review medical documents, diagnosis, treatment, and claim documents to assess eligibility and accuracy.

• Validate claims against policy benefits, coverage, exclusions, and applicable terms & conditions.

• Handle reimbursement claims for both corporate and individual members.

• Manage and resolve complex claim cases, including discrepancies and potential irregularities.

• Coordinate with members, corporate PICs, healthcare providers, agents, and internal teams when required.

• Ensure accurate and timely claim processing in accordance with SLA/TAT and company procedures.

• Support claim billing, reporting, and documentation processes.

• Identify opportunities for claim process improvement and provide recommendations.

KUALIFIKASI MINIMUM

Requirements:

• Minimum Bachelor's degree in Nursing.

• Minimum 3 years of experience in Health/Reimbursement Claims, preferably with inpatient reimbursement experience.

• Strong understanding of medical documents, claim analysis, and policy benefits.

• Strong analytical, problem-solving, communication, and attention-to-detail skills.

• Able to work independently and collaborate effectively with multiple stakeholders.

RINGKASAN PERKERJAAN

• *SPESIALISASI**: Health and Medical
• *PENDIDIKAN MINIMAL**: S1 (Sarjana)
• *SISTEM KERJA**: On-site
• *TIPE PEKERJAAN**: Contractual
• *LOKASI**: East Jakarta, DKI Jakarta, Indonesia
• *INDUSTRI**: Information Technology / IT
• *SITUS PERUSAHAAN**: http://rds.co.id

TENTANG PERUSAHAAN

PT Reycom Document Solusi (RDS) is a corporation that consists of several companies working collaboratively in order to meet the need for digital solutions. RDS Group was created in 2003 in Jakarta under RDS has been expanded in establishing subsidiaries with the same business focus that provides a wide range of Integrated IT-based business management solutions in Indonesia and Asia. RDS Group has grown into 4 pillars of business focus: Business Process Outsourcing (BPO), System Integration, Printing and Creative Services, and Healthcare Management. As we accelerate our business growth, we recognize our greatest asset is our Human Resources. We invite motivated and experienced professionals to join our dynamic team and contributor to our success. Explore an exciting career at RDS, where opportunities and excellence converge.