Medical Doctor

PT. PRIMA SARANA JASA; Jakarta Utara; On-site; IDR 300.000.000 - 400.000.000; Full time

Job summary

A leading healthcare third-party administrator is seeking a Medical Claim Analyst in Jakarta. The ideal candidate will assist in managing medical claims and ensure timely processing while maintaining relationships with medical providers and clients. Candidates should have a Degree in Medicine and at least 1-2 years of relevant experience. Strong communication skills in English and Bahasa Indonesia are required.

Qualifications

• 1-2 years working experience as a Medical Doctor/Medical Claim Analyst in TPA or Insurance Industry.
• Knowledge about Insurance, especially Health will be an advantage.

Responsibilities

• Attend Case Quality Review in Operation Excellence every working day.
• Assist in obtaining sufficient medical reports from medical providers.
• Ensure reviewing medical reports is done promptly to fulfil Turn Around Time (TAT).
• Negotiate with medical providers for the best pricing.
• Maintain good relationship with medical providers and clients.

Skills

Service-centred mindset

Strong written and spoken English

Strong written and spoken Bahasa Indonesia

Education

Degree in Medicine

Job description

Role Overview

Attend transmission and attend Case Quality Review in Operation Excellence every working day and duty day and give case directly to the best of his/her knowledge.

Assist daily activity in the Operation Excellence Department in obtaining sufficient medical reports from the medical providers to move the case forward.

Assist daily activity in the Operation Excellence Department to ensure reviewing medical reports from the medical providers are done promptly to fulfil the Turn Around Time (TAT).

Assist daily activity in the Operation Excellence Department in providing recommended medical providers for clients.

Assist daily activity in the Operation Excellence Department to negotiate with the medical provider for the best pricing, corporate price, or discount and to review the hospital billings whenever required.

Have a good relationship with the medical providers and ensure that the medical providers will provide the best quality of healthcare rendered by our clients.

Conduct billing audits of all received invoices before any payment to get the best review of medical claims.

Ensure all information related to the case activities is well documented in the system.

Ensure that all close cases/claims have the ICD-10 verified in the system.

Handle any complaints raised by clients or service providers towards the Operation Excellence Department.

Escalate to Medical Claim Excellence’s Assistant Manager if the complaint is serious and needs further follow‑up to mitigate service recovery.

Accountable for assisting other departments and crisis management centers with a special task or mission.

Maintain a good working environment, and develop good teamwork among colleagues and staff by maintaining good communication.

Ensure that all procedure, policy, and company information is maintained to the latest date issued by the Quality Control and Continuous Improvement of Company policy.

Establish a collaborative and cooperative relationship among the staff, to create a conducive working environment and conditions. To foster the motivation of the staff to work at optimal efficiency.

Qualifications

• Preferably 1-2 years working experience as a Medical Doctor/Medical Claim Analyst in TPA or Insurance Industry
• Degree in Medicine
• Knowledge about Insurance, especially Health will be an advantage
• Possess a service‑centred mindset
• Strong written and spoken English and Bahasa Indonesia

About Global Excel

Global Excel in Indonesia (PT Prima Sarana Jasa) is a third‑party administrator (TPA) with over 2 decades of experience in the Indonesian healthcare market. Global Excel provides payers with a consultative approach to cost‑effective, quality care programs through a single partnership. We deliver seamlessly tailored solutions 24/7 through our customer service and medical professionals by providing access to our network of certified healthcare facilities, ensuring highly effective cost containment. At Global Excel, we’re aiming to transform and simplify access to quality healthcare. We strive to exceed customer expectations in everything we do.