Medical Doctor ( Clinical Validator)

Sembuh AI; Jakarta Utara; On-site; IDR 350,000,000 - 650,000,000; Full time

Job summary

Sembuh AI in Jakarta is seeking a medically trained reviewer to validate AI-generated clinical outputs for insurance claims. You will review diagnoses, records, and coding to ensure medical accuracy and compliance.

You will collaborate with ML and product teams, develop validation guidelines, and communicate findings to insurer partners in clear terms.

Qualifications

• Valid medical degree (MD or equivalent) with active license in Indonesia.
• Minimum 3 years of clinical practice.
• Experience as Case management doctor or casemix doctor preferred.
• Ability to interpret medical records, diagnostic tests, treatment protocols, and guidelines for claims assessment.
• Experience with AI, digital health, or health informatics preferred.
• Strong analytical, communication, and decision-making skills.
• Excellent English and Bahasa Indonesia, with ability to explain clinical concepts to non-medical stakeholders.

Responsibilities

• Review and validate AI-generated medical assessments, diagnoses, and clinical recommendations escalated for human review.
• Assess clinical accuracy against medical records, ICD codes, and best practices.
• Identify medically implausible claims and patterns indicating fraud or error.
• Collaborate with ML and product teams to improve clinical accuracy of AI models.
• Develop and maintain clinical review guidelines and validation criteria.
• Present clinical findings and validation results to client stakeholders, including insurer partners.
• Stay current with developments in medical guidelines and coding practices.

Skills

Medical degree (MD or equivalent)

Active medical license in Indonesia

Clinical experience (3+ years)

Medical records interpretation

ICD codes familiarity

Quality assurance / validation

English and Bahasa Indonesia comms

Education

MD or equivalent medical degree

Job description

Sembuh AI is a fast-growing AI company building technology for the insurance industry in Indonesia. We work with some of the country's leading insurers, bringing AI into real production environments where accuracy, reliability, security, and execution matter.

About the role

This role involves reviewing and validating AI-generated medical assessments, diagnoses, and clinical recommendations escalated for human review. You will assess the clinical accuracy and appropriateness of AI outputs against medical records, ICD codes, and clinical best practices, identify medically implausible claims and patterns indicative of fraud or error, and serve as the internal medical authority for questions related to clinical validity, medical necessity, and coding accuracy.

Key responsibilities

Review and validate AI-generated medical assessments, diagnoses, and clinical recommendations escalated for human review

Assess the clinical accuracy and appropriateness of AI outputs against medical records, ICD codes, and clinical best practices

Identify medically implausible claims, inconsistencies in treatment records, and patterns indicative of fraud or error

Collaborate with the ML and product teams to improve clinical accuracy and reasoning of AI models, providing structured feedback on model errors and edge cases

Develop and maintain clinical review guidelines and validation criteria for the platform

Serve as the internal medical authority for questions related to clinical validity, medical necessity, and coding accuracy

Stay current with developments in medical guidelines, insurance health standards, and clinical coding practices

Present clinical findings and AI validation results to client stakeholders, including non-medical audiences such as insurance executives and operations teams

About you

Valid medical degree (MD or equivalent) from an accredited institution and active medical license in Indonesia

Minimum 3 years of clinical practice; background as Case management doctor, casemix doctor, or a relevant specialty preferred with exposure to hospital or insurance settings

Strong ability to interpret medical records, diagnostic tests, treatment protocols, and clinical guidelines for claims assessment

Able to assess and provide structured feedback on automated medical analysis

Comfortable working with data-driven tools and technology platforms; interest in AI, digital health, or health informatics is strongly preferred

Excellent analytical, critical thinking, and decision-making skills with high attention to detail and clinical accuracy

Collaborative mindset, with the ability to work in cross-functional teams and adapt in a fast-paced, innovation-focused environment

Strong verbal and written communication skills with clear, structured delivery; able to simplify complex medical concepts without losing accuracy

Clear and concise written and verbal communication skills in English and Bahasa Indonesia, with the ability to explain clinical concepts to non-medical stakeholders

Confident in client-facing settings: meetings, reviews, and joint sessions with insurer partners