Claim Assessor (Insurance & English Proficiency)

PT. PRIMA SARANA JASA; Jakarta Utara; On-site; IDR 133,920,000 - 223,200,000; Full time

Benefits offered by this job

Medical benefits

Dental insurance

Performance bonus

BPJS Kesehatan

Retirement

Job summary

Global Excel Indonesia (PT Prima Sarana Jasa) is seeking a diligent Claim Assessor to evaluate insurance claims in accordance with policy coverage and internal guidelines. The role emphasizes strong English communication to liaise with policyholders, providers, and teams, ensuring accurate, timely decision-making.

You will review documents, medical reports, and invoices, identify fraudulent activity, maintain records, and collaborate with cross-functional teams to improve claims processes, while

Qualifications

• Review and analyze insurance claims based on policy coverage and company guidelines.
• Assess supporting documents, medical reports, and invoices to determine claim validity.
• Communicate with policyholders, healthcare providers, and internal teams to clarify claim details.
• Ensure timely and accurate claim processing while maintaining compliance with regulations.
• Identify and report fraudulent or suspicious claims.
• Provide clear and professional explanations to clients regarding claim decisions.
• Maintain accurate records and documentation of claim assessments.
• Collaborate with cross-functional teams to enhance claim assessment processes.

Responsibilities

• Review and analyze insurance claims based on policy coverage and company guidelines.
• Assess supporting documents, medical reports, and invoices to determine claim validity.
• Communicate with policyholders, healthcare providers, and internal teams to clarify claim details.
• Ensure timely and accurate claim processing while maintaining compliance with regulations.
• Identify and report fraudulent or suspicious claims.
• Provide clear and professional explanations to clients regarding claim decisions.
• Maintain accurate records and documentation of claim assessments.
• Collaborate with cross-functional teams to enhance claim assessment processes.

Skills

Analytical thinking

English proficiency

Communication skills

Attention to detail

Education

Bachelor's degree in related field

Job description

Claim Assessor (Insurance & English Proficiency)

As a Claim Assessor at Global Excel Indonesia, you will be responsible for evaluating and processing insurance claims by analyzing policy coverage, reviewing supporting documents, and ensuring compliance with company guidelines. This role requires strong analytical skills, attention to detail, and proficiency in English to effectively communicate with policyholders, healthcare providers, and internal teams while ensuring accurate and timely claim assessments.

Key Responsibilities:

• Review and analyze insurance claims based on policy coverage and company guidelines.
• Assess supporting documents, medical reports, and invoices to determine claim validity.
• Communicate with policyholders, healthcare providers, and internal teams to clarify claim details.
• Ensure timely and accurate claim processing while maintaining compliance with regulations.
• Identify and report fraudulent or suspicious claims.
• Provide clear and professional explanations to clients regarding claim decisions.
• Maintain accurate records and documentation of claim assessments.
• Collaborate with cross-functional teams to enhance claim assessment processes.

This role demands strong English communication skills, both written and verbal, to handle international cases effectively.

Global Excel in Indonesia (PT Prima Sarana Jasa) is a third-party administrator (TPA) with over 2 decades of experience in the Indonesian healthcare market.

Global Excel provides payers with a consultative approach to cost-effective, quality care programs through a single partnership. We deliver seamlessly tailored solutions 24/7 through our customer service and medical professionals by providing access to our network of certified healthcare facilities, ensuring highly effective cost containment.

At Global Excel, we’re aiming to transform and simplify access to quality healthcare. We strive to exceed customer expectations in everything we do.

Global Excel in Indonesia (PT Prima Sarana Jasa) is a third-party administrator (TPA) with over 2 decades of experience in the Indonesian healthcare market.

Global Excel provides payers with a consultative approach to cost-effective, quality care programs through a single partnership. We deliver seamlessly tailored solutions 24/7 through our customer service and medical professionals by providing access to our network of certified healthcare facilities, ensuring highly effective cost containment.

At Global Excel, we’re aiming to transform and simplify access to quality healthcare. We strive to exceed customer expectations in everything we do.

Perks and benefits Medical Miscellaneous allowance Dental THR, Bonus Performance, BPJS Kesehatan , Pensiun,