Careers & Jobs at PT. Prima Sarana Jasa

QA Supervisor (TPA Insurance)

PT. Prima Sarana Jasa

PT. Prima Sarana Jasa (South Jakarta, Jakarta)

DKI Jakarta, Indonesia

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. As a Global Excel family member, we can support our clients with their growth needs. 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.

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Job function: Quality Management

Industries: Management and Consultancy Services Healthcare and Medical

About this position

The QA Supervisor (TPA Insurance) is responsible for ensuring the quality and compliance of claims processing through audits, training, and collaboration with various teams.

Responsibilities

• Conduct regular audits of claim files to ensure compliance with company guidelines, insurance policies, and regulatory requirements.
• Develop and implement QA procedures for claims processing to ensure accuracy, consistency, and timeliness in the settlement of claims.
• Monitor and evaluate the performance of the claims team through KPIs such as processing accuracy, customer satisfaction, and turnaround time. Provide feedback and training where necessary.
• Ensure all claims processing activities adhere to regulatory standards, mitigating any potential risks through early detection of compliance gaps.
• Analyze QA reports and provide insights to senior management on claims trends, areas of concern, and improvement opportunities.
• Train and mentor the claims team on QA standards, ensuring they are up to date with policies, procedures, and best practices.
• Collaborate with claims adjusters, customer service, and IT teams to streamline the claims handling process and implement new technologies or procedures to enhance efficiency.
• Monitor customer feedback related to claims processes, identify recurring issues, and recommend solutions to improve service quality.
• Work with the claims and customer service teams to investigate and resolve complex claims issues or complaints, ensuring timely and satisfactory resolutions.

Requirements

• 3-5 years of experience in claims handling, quality assurance, or supervision, preferably in a TPA or insurance company.
• Bachelor’s degree in insurance, business administration, or a related field.
• Strong knowledge of claims processing and TPA insurance operations.
• Strong written and spoken English and Bahasa Indonesia.
• Familiarity with local and international insurance regulations and compliance standards.

Benefits

Huneety A.I Salary Estimate

9,000,000 - 26,000,000 IDR per month

PT. Prima Sarana Jasa

2 jobs

List of jobs found:

QA Supervisor (TPA Insurance)

Claim Assessor (Medical Doctor)

QA Supervisor (TPA Insurance)

About this position

Responsibilities

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About PT. Prima Sarana Jasa