Medical Claim Junior Officer

Blibli; Jakarta Pusat; Vor Ort; IDR 133.920.000 - 200.880.000; Vollzeit

Zusammenfassung

Blibli is seeking a Medical Claim Junior Officer to ensure employees receive appropriate healthcare benefits through accurate medical claim assessments. You will interpret diagnoses, evaluate treatments, and coordinate with healthcare providers to resolve issues, contributing to broader employee well-being initiatives.

The role requires a strong healthcare background and at least 3 years of relevant experience in medical claims or health insurance, with excellent attention to detail and

Qualifikationen

• Bachelor’s degree in Healthcare, Nursing, Pharmacy, Public Health, Medicine, or related field.
• Minimum 3 years of relevant experience in Medical Claims, Healthcare Administration, Health Insurance, or similar roles.
• Strong medical knowledge including diseases, diagnoses, and treatments.
• Ability to read and interpret doctors' prescriptions and notes.

Aufgaben

• Review and analyze employee medical claims (outpatient, inpatient, dental, optical).
• Evaluate claim eligibility based on medical information, insurance coverage, and policies.
• Coordinate with insurance companies, hospitals, and providers to manage claims.
• Monitor pending claims and follow up on discrepancies or suspicious claims.
• Prepare and monitor medical claim payment requests.
• Analyze healthcare utilization to recommend benefit improvements.

Kenntnisse

Strong medical knowledge

Communication skills

Analytical thinking

Attention to detail

Excel

Ausbildung

Bachelor's in Healthcare/Medicine/Nursing/Public Health

Tools

Microsoft Excel

Jobbeschreibung

1 - 5 Years

Job Description

About the Role

Blibli is on a journey to build a highly effective, future-ready workplace where employee health and well-being are essential to creating a supportive and sustainable working environment.

As a Medical Claim Junior Officer , you will help ensure employees receive appropriate healthcare benefits through accurate medical claim assessments, effective coordination with healthcare providers, and timely resolution of medical-related issues.

We’re looking for someone with a strong healthcare background and solid medical knowledge , who can understand diagnoses, interpret prescriptions, evaluate medical treatments, and navigate healthcare-related matters with confidence. Beyond claim administration, you’ll contribute to improving employee healthcare experiences and supporting our broader employee well-being initiatives .

What You’ll Do

Review and analyze employee medical claims, including outpatient, inpatient, dental, and optical benefits , by assessing diagnoses, prescriptions, medications, treatments, and supporting medical documents.

Evaluate claim eligibility and accuracy based on medical information, insurance coverage, company benefit policies, and applicable guidelines.

Coordinate with insurance companies, hospitals, and healthcare providers to manage claim administration, resolve medical-related issues, and maintain effective partnerships.

Monitor pending claims, investigate discrepancies or suspicious claims, and ensure timely follow-up and resolution.

Prepare and monitor medical claim payment requests, ensuring accurate documentation and timely settlement.

Analyze healthcare utilization, medical claim trends, and employee health needs to provide recommendations for benefit improvements and employee well-being initiatives.

Stay updated on healthcare developments, medical regulations, mental health, and employee well-being trends to support effective healthcare benefit management.

What You’ll Bring to the Team

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

Minimum 3 years of relevant experience in Medical Claims, Healthcare Administration, Health Insurance, Medical Benefits, or a similar role.

Strong medical knowledge , including understanding of diseases, diagnoses, medical terminology, treatments, and healthcare procedures.

Ability to read and interpret doctors' prescriptions, medical notes, and supporting documents , with a good understanding of medications and their uses.

Familiarity with health insurance processes, medical claim assessment, healthcare regulations, and employee medical benefits .

Strong communication and coordination skills , particularly when dealing with insurance companies, hospitals, healthcare providers, and other external partners.

Excellent attention to detail, analytical thinking, and investigative skills to identify claim discrepancies and assess medical information accurately.

Good proficiency in Microsoft Excel and reporting, with an interest in current healthcare issues, including mental health and employee well-being .

Why You’ll Love Working Here

At Blibli, you’ll have the opportunity to apply your healthcare expertise beyond traditional clinical settings and make a meaningful impact on employees’ everyday well-being.

You’ll work closely with healthcare partners, analyze medical trends, and help improve the way employees access and experience their healthcare benefits.

Join a collaborative Human Capital team where your medical knowledge and analytical skills can make a real difference as we continue growth — transforming together.

Make the healthcare background more prominentAdd the unfinished candidate requirement

Job Snapshot

Job ID

JOB_151

Location