Claim Assessor (Medical Doctor)
About this position
Responsibilities
• Analyzes all information pertaining to a claim including medical summaries, medical declarations, policy wording and file specific communications.
• Ensure evidence validation in compliance with client directives.
• Proactively obtain and compile necessary information in order to achieve efficient turnaround time.
• Monitor missing information for escalated claims and intervene, when necessary, involve leadership where applicable.
• Ensures policy wording, medical declaration and intent are applied precisely.
• Prepare clear case summaries for corporate client submission where GEM’s authority thresholds are exceeded.
• Handle appeals, participate in internal and client rounds and provide guidance in active case management.
• Communicate claim progress and coverage issues to claimants.
• Request missing claim components for adjudication.
• Compose denial letters and handle communication regarding claim denials.
Requirements
• Preferably 1-2 years working experience as a Medical Doctor but Fresh Graduates are welcome to apply.
• Have a degree in Medicine.
• Strong written and spoken English and Bahasa Indonesia.
• Knowledge about Insurance, especially Health will be an advantage.