Clinical Review Operations Lead

PT Asuransi Allianz Life Indonesia; Jakarta Utara; On-site; IDR 145,080,000 - 212,040,000; Full time

Job summary

PT Asuransi Allianz Life Indonesia is seeking an experienced professional to manage the Concurrent Review Operations. You will oversee daily concurrent review activities for inpatient and high-cost cases, ensuring reviews are completed within SLA and aligned with clinical guidelines.

This role requires strong clinical judgment, leadership, and the ability to collaborate with Medical Hotline, Medical Management, Claims, Underwriting, and Provider teams to maintain audit readiness, achieve

Qualifications

• Medical degree or equivalent clinical qualification.
• 5–7 years of experience in the insurance industry with clinical exposure.
• Leadership or supervisory experience.

Responsibilities

• Oversee daily concurrent review activities for inpatient and high-cost cases
• Ensure all cases are reviewed within SLA and aligned with clinical guidelines
• Monitor length of stay (LOS) and ongoing treatment appropriateness
• Act as escalation point for complex or critical cases
• Ensure consistent application of evidence-based medical guidelines
• Review and validate complex or borderline cases
• Maintain documentation quality and audit readiness
• Engage with hospitals and treating physicians on ongoing cases
• Collaborate with Medical Hotline, Medical Management, Claims, Underwriting, and Provider teams

Skills

Clinical judgment

Analytical thinking

Communication

Negotiation

Attention to detail

Fast decision making

Education

Medical Degree

Job description

PT Asuransi Allianz Life Indonesia is seeking an experienced professional to manage the Concurrent Review Operations. You will oversee daily concurrent review activities for inpatient and high-cost cases, ensuring reviews are completed within SLA and aligned with clinical guidelines.

This role requires strong clinical judgment, leadership, and the ability to collaborate with Medical Hotline, Medical Management, Claims, Underwriting, and Provider teams to maintain audit readiness, achieve