Claim Assessor (Medical Doctor)

PT. Prima Sarana Jasa

PT. Prima Sarana Jasa (South Jakarta, Jakarta)

DKI Jakarta, อินโดนีเซีย

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.

คลิกเพื่อดูงานที่คล้านกันในประเทศ อินโดนีเซีย:

ฝ่าย: วิชาชีพด้านสุขภาพและการแพทย์

อุตสาหกรรม: การจัดการและการให้คำปรึกษา การดูแลสุขภาพและการแพทย์

เกี่ยวกับตำแหน่งนี้

The Claim Assessor (Medical Doctor) is responsible for analyzing claims, ensuring compliance with client directives, and managing communication regarding claims and denials.

หน้าที่รับผิดชอบ

• 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.

คุณสมบัติ

• 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.

สิทธิประโยชน์

Huneety A.I Salary Estimate

5,000,000 - 13,000,000 IDR per month