Provider Improvement & Monitoring (Medical Analytics)

Prudential Indonesia (PT Prudential Life Assurance); Jakarta Pusat; On-site; IDR 223,200,000 - 446,400,000; Full time

Job summary

Prudential Indonesia (PT Prudential Life Assurance) is seeking a Medical Doctor (MD) to join our medical analytics team. You will conduct utilization reviews per national guidelines, support cost containment with providers, and help evolve workflows and tools for utilization management.

The role requires strong clinical judgement, analytical skills, and proficiency in MS Office; experience with BPJS casemix is a plus. We value equality of opportunity for all applicants across diverse backgrounds.

Qualifications

• MD with minimum Bachelor's degree.
• Strong clinical judgement, analytical, and problem-solving skills.
• Knowledge of MS Office; Excel & PowerPoint advantageous.
• Having experience with BPJS casemix is an advantage.
• Knowledge of provider relations and claim processes.

Responsibilities

• Analyze utilization review according to national guidelines (OJK requirement) and internal policies.
• Support cost containment initiatives with healthcare providers (drug formulary, EBP, Package Pricing, etc).
• Adapt to evolving workflows, tools, and utilization management practices.
• Support Medical Review and Analytics Hospital (Cost trend, Utilization trend, High-cost provider, High-cost diagnosis, Readmission, Length of Stay (LOS)).

Skills

Analytical skills

Clinical judgement

Problem solving

Education

Bachelor's degree

Tools

MS Office

Job description

Prudential’s purpose is to be partners for every life and protectors for every future. Our purpose encourages everything we do by creating a culture in which diversity is celebrated and inclusion assured, for our people, customers, and partners. We provide a platform for our people to do their best work and make an impact to the business, and we support our people’s career ambitions. We pledge to make Prudential a place where you can Connect, Grow, and Succeed.

Responsibilities:

• Analyze utilization review according to national guidelines (OJK requirement) and internal policies
• Understand and support initiatives related to cost containment with healthcare providers (drug formulary, EBP, Package Pricing, etc)
• Adapt to evolving workflows, tools, and utilization management practices
• Support Medical Review and Analytics Hospital (Cost trend, Utilization trend, High-cost provider, High-cost diagnosis, Readmission, Length of Stay (LOS))

Requirements:

• Medical Doctor (MD) with a minimum of a Bachelor’s degree
• Strong clinical judgement, analytical, and problem-solving skills
• Have a general knowledge in MS Office (Excel & Power Point is advantage)
• Having experience with BPJS casemix is an advantage
• Knowledge of best practice in provider relation and claim process

Prudential is an equal opportunity employer. We provide equality of opportunity of benefits for all who apply and who perform work for our organization irrespective of sex, race, age, ethnic origin, educational, social and cultural background, marital status, pregnancy and maternity, religion or belief, disability or part-time / fixed-term work, or any other status protected by applicable law. We encourage the same standards from our recruitment and third-party suppliers taking into account the context of grade, job and location. We also allow for reasonable adjustments to support people with individual physical or mental health requirements.