Healthcare Claims Analyst – Benefits & Compliance

PT Global Digital Niaga (blibli.com); Jakarta Pusat; On-site; IDR 167,400,000 - 290,160,000; Full time

Job summary

Blibli.com is seeking a Healthcare Claims Analyst to review and analyze employee medical claims across outpatient, inpatient, dental, and optical benefits. You will evaluate eligibility, coordinate with insurers and healthcare providers, and ensure timely settlement with accurate documentation.

The role requires 3+ years in Medical Claims or Health Administration, strong medical knowledge, and proficiency in Excel/PowerPoint to present data-driven insights for benefit improvements.

Qualifications

• Bachelor’s degree in a health-related field is required.
• Minimum 3 years of relevant medical claims or healthcare administration experience.
• Strong medical knowledge and ability to interpret medical documents.

Responsibilities

• Review and analyze employee medical claims, including outpatient, inpatient, dental, and optical benefits.
• Evaluate claim eligibility and accuracy based on guidelines and policies.
• Coordinate with insurers, hospitals, and providers to manage claims.
• Monitor pending claims and investigate discrepancies for timely resolution.
• Prepare and monitor medical claim payment requests with proper documentation.
• Analyze utilization and trends to support benefit improvements and employee wellbeing.
• Stay updated on healthcare developments and regulations affecting benefits.

Skills

Strong communication and coordination

Analytical thinking

Attention to detail

Reading and interpreting prescriptions

Data analysis

Microsoft Excel

PowerPoint

Education

Bachelor's degree in Healthcare, Nursing, Pharmacy, Public Health, Medicine, or another health-related field

Tools

Microsoft Excel

PowerPoint

Job description

Blibli.com is seeking a Healthcare Claims Analyst to review and analyze employee medical claims across outpatient, inpatient, dental, and optical benefits. You will evaluate eligibility, coordinate with insurers and healthcare providers, and ensure timely settlement with accurate documentation.

The role requires 3+ years in Medical Claims or Health Administration, strong medical knowledge, and proficiency in Excel/PowerPoint to present data-driven insights for benefit improvements.