Group Health Claim Officer

ASURANSI JIWA BCA; Jakarta Pusat; On-site; IDR 90,000,000 - 150,000,000; Full time

Job summary

ASURANSI JIWA BCA is seeking a Claims Analyst to review and analyze health insurance claims, ensuring completeness, accuracy, and compliance with policy terms and company guidelines. You will handle processing, assessment, approval or decline, and submission of claim payments in line with SLAs and policy provisions.

You will prepare accurate claim reports, perform data analysis, monitor vendor payment processes, and provide insights to improve operational performance.

Qualifications

• Bachelor's degree in a health-related field such as Medicine, Public Health, Nursing, Pharmacy, or related discipline.
• Minimum 2 years of experience in Group Health Claims within health insurance or TPA industry.
• Good understanding of health insurance claim processes, policy administration, and claim assessment.
• Strong analytical skills, attention to detail, and problem-solving abilities.
• Ability to work effectively in a fast-paced environment, manage priorities, and meet established service targets.
• Strong communication skills and a commitment to delivering high-quality service.

Responsibilities

• Review and analyze health insurance claims to ensure completeness, accuracy, and compliance with policy terms and company guidelines.
• Process, assess, approve, decline, and submit claim payments in accordance with established SLAs and policy provisions.
• Prepare accurate and timely claim reports, conduct data analysis, and provide insights to support operational performance.
• Monitor and evaluate vendor payment processes to ensure accuracy, completeness, and timely settlement.
• Ensure all claim handling activities comply with internal procedures, service standards, and business objectives.
• Collaborate with internal teams and external stakeholders to maintain effective claim operations and deliver excellent service to corporate clients.

Skills

Analytical skills

Attention to detail

Problem solving

Communication skills

Fast-paced environment experience

Education

Bachelor's degree in health-related field

Job description

Review and analyze health insurance claims to ensure completeness, accuracy, and compliance with policy terms and company guidelines.

Process, assess, approve, decline, and submit claim payments in accordance with established SLAs and policy provisions.

Prepare accurate and timely claim reports, conduct data analysis, and provide insights to support operational performance.

Monitor and evaluate vendor payment processes to ensure accuracy, completeness, and timely settlement.

Ensure all claim handling activities comply with internal procedures, service standards, and business objectives.

Collaborate with internal teams and external stakeholders to maintain effective claim operations and deliver excellent service to corporate clients.

Requirements:

Bachelor's degree in a health-related field, such as Medicine, Public Health, Nursing, Pharmacy, or a related discipline.

Minimum 2 years of experience in Group Health Claims within the health insurance or Third-Party Administrator (TPA) industry.

Good understanding of health insurance claim processes, policy administration, and claim assessment.

Strong analytical skills, attention to detail, and problem-solving abilities.

Ability to work effectively in a fast-paced environment, manage priorities, and meet established service targets.

Strong communication skills and a commitment to delivering high-quality service.