Health Insurance Pricing & Actuarial Risk Lead

Outsized; Indonesia; Hybrid; IDR 669,600,000 - 1,004,400,000; Part time

Job summary

Outsized, a global insurer, is seeking an actuarial and pricing consultant to strengthen medical reimbursement pricing and claims management in Indonesia.

The role requires deep expertise in actuarial modelling, pricing for health and medical reimbursement, and experience mitigating fraud and leakage. You will build robust models, advise on pricing adjustments, and collaborate with underwriting, product, and claims teams to ensure portfolio sustainability.

Qualifications

• 10–20 years in actuarial analysis, health pricing, or claims analytics.
• Strong medical pricing and modelling experience; healthcare cost dynamics.
• Ability to analyse claims data, cost drivers, and profitability.
• Experience in claims management, fraud analytics or leakage.
• Regional SEA experience or comparable markets preferred.
• Actuary designation preferred, but not mandatory with strong modelling.
• Able to provide hands-on analysis and advisory support.

Responsibilities

• Develop actuarial models to analyse medical claims and pricing.
• Review pricing assumptions and assess impact on profitability.
• Analyze claims patterns to improve monitoring and controls.
• Identify fraud indicators and mitigation measures.
• Assess healthcare inflation and provider cost effects on pricing.
• Refine models as new claims data emerges.
• Collaborate with actuarial, underwriting, product, and claims teams to translate findings into recommendations.
• Analysis of historical claims experience, key cost drivers, and emerging trends.
• Actuarial models and supporting analysis for claims forecasting and pricing.
• Pricing adjustment recommendations for sustainability.
• Identify claims management improvements and leakage mitigation opportunities.
• Ongoing model updates, technical guidance, and pricing recommendations throughout the engagement.

Skills

Actuarial Pricing

Medical Claims

Insurance Claims

Health Insurance

Life Insurance

Insurance Underwriting

Insurance Regulation

Job description

Outsized, a global insurer, is seeking an actuarial and pricing consultant to strengthen medical reimbursement pricing and claims management in Indonesia.

The role requires deep expertise in actuarial modelling, pricing for health and medical reimbursement, and experience mitigating fraud and leakage. You will build robust models, advise on pricing adjustments, and collaborate with underwriting, product, and claims teams to ensure portfolio sustainability.