Health Insurance Claim Head

Cermati Fintech Group; Jakarta Utara; On-site; IDR 300.000.000 - 400.000.000; Full time

Job summary

A leading fintech startup in Indonesia seeks an experienced Claim Manager to lead the Employee Benefit Insurance After Sale team. The role involves overseeing claims processing, assisting clients, and ensuring high levels of customer satisfaction. Candidates should have over 5 years of experience in insurance or brokerage firms, strong negotiation skills, and a good understanding of insurance terms. This position promotes a culture of continuous improvement and excellence in client service.

Qualifications

• More than 5 years experience as Claim Manager in insurance or brokerage firms.
• Have good relationships with insurance companies.
• Strong adherence to SLA and maintaining clients expectations.

Responsibilities

• Lead the Employee Benefit Insurance After Sale team including Data and Claim team.
• Process claims, assist clients with endorsements and data keeping.
• Oversee insurance claims to ensure justified results according to agreed TC.
• Assist clients admitted to hospital by coordinating with insurance.
• Make daily, weekly, and monthly report for claim updates.

Skills

Communication skills

Negotiation skills

Persuasion skills

Client expectation management

Problem-solving skills

Job description

Cermati is a financial technology (fintech) startup based in Indonesia. Cermati simplifies the process of finding and applying for financial product 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 hailed from Silicon Valley Tech companies such as Google, Microsoft, LinkedIn and Sofi as well as Indonesian startups such as Doku, 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 After Sale team include processing claims, assist clients with endorsements, documents and data keeping
• Oversees insurance claims that are in progress to make sure claim decision come out according to SLA and claim appraisal result is justified according to the agreed TC
• Assist clients who are admitted to hospital by coordinating with insurance and hospitals when necessary
• Make daily, weekly, and monthly report 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 process and make sure SLA is achieved
• Check and make sure member cards are correct and send them to the clients on time
• Assist with client closing process by coordinating with insurance and making sure the policy T and C is 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 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 experience as Claim Manager in insurance or brokerage firms
• Have good relationships with insurance companies
• Excellent in communication, negotiation, and persuasion skills
• Strong adherence to SLA and maintaining clients expectations
• Able to respond to clients inquiry with lightning speed and accuracy
• Strong understanding of insurance terms and conditions and claim appeal process
• Background in medicine is preferred but not a must