Health Insurance Claim Head

Company Description

Cermati is a financial technology (fintech) startup based in Indonesia. Cermati simplifies the process of finding and applying for financial products by bringing everything online so people can shop around for financial products online and can apply online without having to physically visit a bank.

Our team hails from Silicon Valley tech companies such as Google, Microsoft, LinkedIn, and Sofi, as well as Indonesian startups such as Doku and Touchten. We have graduates from well-known universities such as Universitas Indonesia, ITB, Stanford, University of Washington, Cornell, and many others. We are building a company with the same culture of openness, transparency, drive, and meritocracy as Silicon Valley companies. Join us in our cause to build a world-class fintech company in Indonesia.

Job Description

• Lead the Employee Benefit Insurance After Sale team including Data and Claim team.
• Responsibilities of the After Sale team include processing claims, assisting clients with endorsements, documents, and data keeping.
• Oversee insurance claims that are in progress to ensure claim decisions come out according to SLA and that claim appraisal results are justified according to the agreed TC.
• Assist clients who are admitted to the hospital by coordinating with insurance and hospitals when necessary.
• Make daily, weekly, and monthly reports for claim updates.
• Customer care helpline – 24 hours.
• Develop and maintain relationships with insurance companies’ claim departments.
• Negotiate and appeal rejected claims with insurance.
• Monitor endorsement processes and ensure SLA is achieved.
• Check and ensure member cards are correct and send them to the clients on time.
• Assist with the client closing process by coordinating with insurance and ensuring the policy T and C are as per agreed.
• Put in place control mechanisms that enable achievement of high levels of customer satisfaction.
• Ensure quality and service excellence to clients and achieve 5/5 client satisfaction.
• Continuously improve current systems and processes.
• Promote a culture of high performance and continuous improvement that values learning and commitment to quality.

Qualifications

• More than 5 years of experience as a Claim Manager in insurance or brokerage firms.
• Have good relationships with insurance companies.
• Excellent communication, negotiation, and persuasion skills.
• Strong adherence to SLA and maintaining client expectations.
• Able to respond to client inquiries with lightning speed and accuracy.
• Strong understanding of insurance terms and conditions and the claim appeal process.
• A background in medicine is preferred but not a must.