Medical Reimbursement Pricing & Actuarial Risk Consultant

Outsized; Jakarta Pusat; On-site; IDR 400,000,000 - 700,000,000; Full time

Job summary

Outsized is seeking an actuarial and pricing specialist to strengthen pricing and claims management of its medical reimbursement insurance portfolio in Indonesia. The consultant will develop robust models and recommend pricing adjustments to support portfolio sustainability while addressing rising healthcare costs and claims volatility.

The ideal candidate will bring extensive experience in medical reimbursement pricing, actuarial modelling, and claims analytics, with regional exposure in

Qualifications

• Extensive experience in actuarial analysis and health pricing, with focus on medical reimbursement.
• Ability to analyse claims data, identify cost drivers, and translate findings into pricing actions.
• Strong collaboration with underwriting, product, claims and other teams.

Responsibilities

• Actuarial modelling and analysis: develop and refine models to analyse medical claims experience, trends, cost drivers and portfolio performance.
• Medical reimbursement pricing: review pricing assumptions and methodologies, assess impact on profitability and sustainability.
• Claims management: analyse claims patterns and identify opportunities to improve monitoring, controls and management practices.
• Fraud and leakage mitigation: identify unusual trends and indicators and work with internal teams to mitigate costs.
• Portfolio sustainability: assess inflation, utilization, provider costs and other factors on future claims and pricing.
• Ongoing model refinement: update assumptions as new claims experience emerges and recommend pricing or claims interventions.
• Stakeholder collaboration: translate analytical findings into practical business recommendations with actuarial, underwriting and product teams.
• Historical claims experience analysis, cost drivers and emerging trends.
• Actuarial models and analysis for claims forecasting and pricing.
• Recommendations for pricing adjustments and sustainable portfolio management.
• Identification of claims management improvements and fraud leakage mitigation opportunities.
• Ongoing model updates, technical guidance and pricing recommendations.

Skills

Actuarial modelling

Pricing analytics

Claims analytics

Fraud detection

Stakeholder collaboration

Job description

Our client, a global insurance company, is seeking an actuarial and pricing specialist to strengthen the pricing and claims management of its medical reimbursement insurance portfolio in Indonesia. The consultant will help address rising healthcare costs, claims volatility, and potential fraud or inappropriate claims, while developing robust analytical models and pricing recommendations to support long-term portfolio sustainability.

Key Responsibilities

• Actuarial modelling and analysis: Develop, refine, and apply models to analyse medical claims experience, claims trends, cost drivers, and portfolio performance.
• Medical reimbursement pricing: Review existing pricing assumptions and methodologies, recommend pricing adjustments, and assess their impact on profitability and product sustainability.
• Claims management: Analyse claims patterns and identify opportunities to improve claims monitoring, controls, and management practices.
• Fraud and leakage mitigation: Identify unusual claims trends, potential fraud indicators, and sources of avoidable claims costs, working with relevant internal teams to recommend mitigation measures.
• Portfolio sustainability: Assess the impact of medical inflation, utilisation trends, provider costs, and other relevant factors on future claims and pricing.
• Ongoing model refinement: Provide iterative technical input, update assumptions and models as new claims experience emerges, and recommend further pricing or claims interventions.
• Stakeholder collaboration: Work with actuarial, underwriting, product, claims, and other relevant teams to translate analytical findings into practical business recommendations.
• Analysis of historical claims experience, key cost drivers, and emerging trends.
• Actuarial models and supporting analysis for claims forecasting and medical reimbursement pricing.
• Recommendations for pricing adjustments and sustainable portfolio management.
• Identification of claims management improvements and potential fraud or claims leakage mitigation opportunities.
• Ongoing model updates, technical guidance, and pricing recommendations throughout the engagement.

Ideal Profile

• Typically 10–20 years of relevant experience in actuarial analysis, health insurance pricing, medical reimbursement, or claims analytics.
• Strong experience in medical insurance pricing and actuarial modelling, preferably in markets with rising healthcare costs and complex claims dynamics.
• Proven ability to analyse claims data, identify cost drivers, develop pricing recommendations, and assess portfolio profitability.
• Experience in claims management, fraud analytics, claims leakage, or healthcare cost containment is highly desirable.
• Regional experience across Southeast Asia or other comparable markets is preferred.
• Qualified actuary preferred, but not mandatory if the candidate has strong technical modelling, pricing, and relevant health insurance experience.
• Comfortable providing both hands-on technical analysis and ongoing advisory support to business stakeholders.