Medical Advisor – Group Claims & Process Improvement

Hanwha Life Indonesia; Jakarta Pusat; On-site; IDR 162,000,000 - 198,000,000; Full time

Job summary

Hanwha Life Indonesia is seeking a Medical Advisor (Group Claim) to join our team in Jakarta. You will apply medical expertise to evaluate group insurance claims and advise on treatment appropriateness and policy alignment.

The role also leads strategic projects focused on process improvement, TAT reduction, and digitalizing medical claim assessment. You will collaborate with internal stakeholders to drive innovative, data-driven solutions and ensure successful project delivery.

Qualifications

• Medical professional with insurance industry experience.
• Experience in Life Insurance claims or policy provisions preferred.
• Strong project management and process improvement mindset.

Responsibilities

• Provide medical expertise to evaluate Group Insurance claims.
• Review medical documents, diagnoses, treatment records, and claim-related supporting documents.
• Ensure medical assessment accuracy, treatment appropriateness, and alignment with policy provisions.
• Identify potential medical discrepancies, claim irregularities, and cases requiring further investigation.
• Provide medical insights to support claim decisions and risk mitigation.
• Lead and drive strategic projects related to Group Claim process improvement and operational transformation.
• Identify opportunities to streamline claim processes, improve turnaround time (TAT), and enhance operational efficiency.
• Develop innovative medical assessment approaches, claim management methodologies, and process improvement initiatives.
• Explore opportunities for digitalization, automation, and technology-driven solutions in medical claim assessment.
• Initiate data-driven projects to identify claim patterns, medical cost trends, and opportunities for better claim management.
• Collaborate with internal stakeholders to implement new initiatives and ensure successful project delivery.
• Monitor project performance, evaluate outcomes, and ensure continuous improvement.

Job description

Hanwha Life Indonesia is seeking a Medical Advisor (Group Claim) to join our team in Jakarta. You will apply medical expertise to evaluate group insurance claims and advise on treatment appropriateness and policy alignment.

The role also leads strategic projects focused on process improvement, TAT reduction, and digitalizing medical claim assessment. You will collaborate with internal stakeholders to drive innovative, data-driven solutions and ensure successful project delivery.