Senior Medical Reimbursement Pricing & Actuarial 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

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