Claim Manager

Pengiklan Anonim; Jakarta Utara; On-site; IDR 100.000.000 - 200.000.000; Full time

Job summary

A health insurance company located in Jakarta Utara is seeking a Claims Manager / Claim Operations Lead who will oversee daily claims operations, ensuring adherence to standards and timely handling. You will lead a team, assess complex claims, and optimize processes, requiring strong knowledge of health insurance and proven experience in claims operations. The ideal candidate will hold a relevant Bachelor’s degree and have excellent communication and problem-solving skills. Join us to bring improvements in claims management.

Qualifications

• 4–5 years of experience in claims operations or case monitoring.
• Experience in leading teams and managing daily operations.
• Knowledge of health insurance products and claim processes.

Responsibilities

• Oversee daily claims activities ensuring service level adherence.
• Assess and approve complex claim cases.
• Contribute to process optimization and automation initiatives.

Skills

Team leadership

Analytical thinking

Effective communication

Problem-solving

Education

Bachelor’s degree in Health Sciences or related fields

Job description

We are seeking a Claims Manager / Claim Operations Lead to assist in overseeing daily health insurance claims operations. This position plays a key role in ensuring claim handling is carried out accurately, timely, and in accordance with established procedures and service standards. The role involves team supervision, cross-functional coordination, and continuous improvement of claims-related processes and systems.

Key Responsibilities

• Oversee daily claims handling activities and ensure adherence to service level standards.
• Assess and approve complex or escalated claim cases.
• Track and evaluate team performance, including productivity and accuracy.
• Contribute to process optimization and digital or automation initiatives.
• Liaise with internal stakeholders and external parties regarding claim-related matters.
• Support the development of team capabilities through training and coaching activities.

Requirements

• Bachelor’s degree in Health Sciences, Insurance, or other medical-related disciplines (such as Medicine or Nursing).
• At least 4–5 years of experience in claims operations or case monitoring within a health insurance or TPA environment.
• Demonstrated experience in leading teams and managing daily operational activities.
• Strong knowledge of health insurance products, claim assessment processes, and managed care systems.
• Solid understanding of medical terminology, particularly related to treatments and surgical procedures.
• Strong analytical thinking, problem-solving abilities, and effective communication skills.
• Availability to support urgent claim matters or escalations when required.