Clinical Claims Advisor: Medical Review & Pre-Authorization

Manulife/John Hancock; Jakarta Pusat; Hybrid; IDR 150,000,000 - 210,000,000; Full time

Job summary

Manulife/John Hancock is seeking a Medical Helpdesk Support to review and assess medical claims from a clinical perspective, ensuring treatments, diagnoses, and hospitalizations align with medical guidelines and company policies. The role supports pre-approval requests and reviews medical documents.

You will collaborate with hospitals and internal teams, interpret medical information, and provide clinical input to support claim decisions.

Qualifications

• Bachelor’s degree in healthcare, medical sciences, nursing, or related field.
• Fresh graduates or doctors with 1–2 years of clinical experience welcome to apply.
• Experience as GP, intern, or hospital/clinic setting is an advantage.

Responsibilities

• Review and assess medical claims (reimbursement and cashless) from a clinical perspective.
• Validate diagnosis, treatment, and hospitalization against guidelines.
• Support pre-authorization processes for hospital and non-hospital cases.
• Assess medical necessity, length of stay, and treatment plans.
• Analyze medical records, discharge summaries, and supporting documents.
• Ensure completeness and accuracy of claim documentation.
• Assist in reviewing medical disputes and appeals.
• Provide clinical input to support claim decisions.
• Follow up on incomplete or unclear documentation.
• Identify potential overutilization or inconsistencies in claims.
• Escalate complex or high-risk cases to Medical Doctor if required.
• Ensure all assessments align with policies and regulatory requirements.

Skills

Analytical skills

Attention to detail

Communication skills

Problem solving

Education

Bachelor’s Degree in Healthcare/Medical Sciences/Nursing

Tools

Microsoft Office

Job description

Manulife/John Hancock is seeking a Medical Helpdesk Support to review and assess medical claims from a clinical perspective, ensuring treatments, diagnoses, and hospitalizations align with medical guidelines and company policies. The role supports pre-approval requests and reviews medical documents.

You will collaborate with hospitals and internal teams, interpret medical information, and provide clinical input to support claim decisions.