Director, Minor Claims QA & Investigation

AIA Indonesia; Jakarta Pusat; Presencial; IDR 900.000.000 - 1.400.000.000; Jornada completa

Descripción de la vacante

AIA Indonesia is seeking an experienced Head of Minor Claims QA and Investigation to lead the QA and investigation functions, ensuring accurate and compliant claim decisions. You will strengthen governance, manage fraud risk, and drive continuous improvements across claims operations.

Strong leadership and English communication are essential. This role calls for strategic oversight of QA frameworks, vendor management, and collaboration with stakeholders to enhance efficiency and customer trust

Formación

• Bachelor’s degree in Medicine is preferred.
• Insurance qualifications (AAJI, ALMI, FLMI, HIA, CFE, ICA) are a plus.
• Minimum 5 years in Life and Health Insurance Claims and at least 3 years in leadership.
• Strong understanding of life and health insurance products and policy provisions.
• Excellent English written and spoken communication.

Responsabilidades

• Lead and manage Minor Claims QA to ensure accurate, consistent assessments.
• Develop QA frameworks, methodologies, and review standards.
• Conduct quality reviews of processed claims including benefit calculations.
• Analyze QA findings, identify root causes, and recommend corrective actions.
• Prepare QA reports, trends, and improvement recommendations.
• Monitor QA performance indicators and drive process improvements.
• Lead investigation activities for suspicious or high-risk claims.
• Ensure investigation outcomes align with policy provisions and regulatory requirements.
• Manage external investigation vendors, ensuring service quality and SLA adherence.
• Review investigation findings and provide recommendations for fraud prevention and risk mitigation.
• Develop and update SOPs, guidelines, and governance documents for Minor Claims QA and Investigation.
• Coach and develop the Minor Claims QA and Investigation team.

Conocimientos

Analytical skills

Problem-solving

Decision-making

Stakeholder management

Communication skills

English proficiency

Educación

Bachelor's Degree in Medicine (Medical Doctor)

Herramientas

Microsoft Office

Data analysis tools

Descripción del empleo

AIA Indonesia is seeking an experienced Head of Minor Claims QA and Investigation to lead the QA and investigation functions, ensuring accurate and compliant claim decisions. You will strengthen governance, manage fraud risk, and drive continuous improvements across claims operations.

Strong leadership and English communication are essential. This role calls for strategic oversight of QA frameworks, vendor management, and collaboration with stakeholders to enhance efficiency and customer trust