Medical Claim Junior Officer

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

• 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.

Responsibilities

• 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.

Requirement

• 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.
• Strong foundational knowledge of data analysis, program management, and employee well-being initiatives, with the ability to process, analyze, and present data effectively using Microsoft Excel, PowerPoint, and other relevant tools.

Unlock job insights

Hirer responsiveness Salary match Number of applicants

Blibli.com is an e-commerce platform built upon a big dream: to lead Indonesians to enter a new digital lifestyle and give only the best shopping experience for a better life. We are committed to conduct our business with customer-centric minded, striving to deliver the best features and services to satisfy our customers. We aim for an exciting challenge to become the number 1 e-commerce platform in Indonesia by providing the best customer-centric experience for both buyers and sellers. Blibli.com is created by Indonesians, in Indonesia, and for Indonesians; we're here as an inspiration to channel and empower the Indonesian people to engage and socialize in commercial activities.

Blibli.com is an e-commerce platform built upon a big dream: to lead Indonesians to enter a new digital lifestyle and give only the best shopping experience for a better life. We are committed to conduct our business with customer-centric minded, striving to deliver the best features and services to satisfy our customers. We aim for an exciting challenge to become the number 1 e-commerce platform in Indonesia by providing the best customer-centric experience for both buyers and sellers. Blibli.com is created by Indonesians, in Indonesia, and for Indonesians; we're here as an inspiration to channel and empower the Indonesian people to engage and socialize in commercial activities.

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