Claim Analyst Reimbursement Senior

PT Reycom Document Solusi; Jakarta Selatan; On-site; IDR 72,000,000 - 120,000,000; Full time

Job summary

PT Reycom Document Solusi is seeking a Health Reimbursement Claims Specialist to analyze inpatient claims and ensure eligibility and accuracy. The role involves reviewing medical documents, validating against policy benefits, and resolving complex cases with various stakeholders.

You will drive timely processing per SLA/TAT and support billing and reporting functions. The ideal candidate holds a Nursing degree with 3+ years of health claims experience, strong analytical abilities, and effective

Qualifications

• Bachelor's degree in Nursing is required.
• At least 3 years of Health/Reimbursement Claims experience, preferably inpatient.
• Strong understanding of medical documents, claim analysis, and policy benefits.
• Excellent analytical, problem-solving, communication, and attention-to-detail skills.
• Able to work independently and collaborate with multiple stakeholders.

Responsibilities

• Analyze and process inpatient health insurance reimbursement claims.
• Review medical documents, diagnosis, treatment and claim documents for eligibility and accuracy.
• Validate claims against policy benefits, coverage, exclusions & terms.
• Handle complex claim cases and resolve discrepancies or irregularities.
• Coordinate with members, corporate PICs, providers, agents and internal teams as needed.
• Ensure accurate and timely claim processing per SLA/TAT and procedures.
• Support claim billing, reporting and documentation processes.
• Identify opportunities for claim process improvement and provide recommendations.

Skills

Analytical skills

Problem-solving

Communication skills

Attention to detail

Education

Bachelor's degree in Nursing

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.

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.