Medical Advisor (For Claim)

Hanwha Life Insurance Indonesia; Jakarta Utara; On-site; IDR 250,000,000 - 350,000,000; Full time

Job summary

Hanwha Life Insurance Indonesia is seeking a Medical Advisor (for Claims) in Jakarta to review and adjudicate medical insurance claims, assess medical necessity, and collaborate with hospitals and internal teams. The role requires applying clinical knowledge and evidence-based medicine to ensure appropriate care and coverage.

The ideal candidate will analyze medical documents, interpret policy terms, and handle complex cases with sound decisions, even when information is incomplete.

Responsibilities

• Review and adjudicate medical insurance claims based on medical documents, diagnosis, treatment, and procedures
• Assess medical necessity and appropriateness of healthcare services, treatments, and medications
• Apply clinical knowledge and evidence-based medicine when evaluating medical cases
• Review medical coding and analyze hospital bills to identify discrepancies, inappropriate charges, or potential overbilling
• Interpret insurance policy terms, benefits, exclusions, limitations, and coverage provisions
• Collaborate with internal teams, hospitals, healthcare providers, and other stakeholders regarding medical and claims-related matters
• Provide medical recommendations and escalations as needed

Job description

Medical Advisor (for Claims) at Hanwha Life Indonesia, a rapidly growing Korea Life Insurance company in Indonesia. The role involves reviewing and adjudicating medical insurance claims, assessing medical necessity, and collaborating with internal teams and healthcare providers.

Key responsibilities

Review and adjudicate medical insurance claims based on medical documents, diagnosis, treatment, and procedures

Assess the medical necessity and appropriateness of healthcare services, treatments, and medications

Apply clinical knowledge and evidence-based medicine when evaluating medical cases

Review medical coding and analyze hospital bills to identify discrepancies, inappropriate charges, or potential overbilling

Interpret insurance policy terms, benefits, exclusions, limitations, and coverage provisions

Analyze claims data and prepare reports to identify trends, irregularities, and areas for improvement

Handle complex cases and make sound decisions even when information is incomplete or ambiguous

Collaborate with internal teams, hospitals, healthcare providers, and other stakeholders regarding medical and claims-related matters

Provide medical recommendations and escalati ... (continued text truncated)...