Head of Claim

3 days ago


Jakarta, Jakarta, Indonesia GREAT EASTERN Full time
Head of Claim (Great Eastern Life Indonesia)

Job Description:

  • Monitor and ensure claim process within agreed TAT, policies & procedures, and company regulations.
  • Make decision on claim payment within authority limit.
  • Ensure all reports related to claims, including analysis, are submitted within agreed deadlines and claim procedures.
  • Check claim guidelines and procedures in Claim and Provider Relations.
  • Monitor and provide responses regarding complaints related to claims.
  • Monitor and ensure TPA (Third Party Administrator) processes are in accordance with agreements, and support TPA in assuring decisions on coverage & GL.
  • Support the development and revamp of policy wording.
  • Visit hospitals/clinics to offer cooperation as Great Eastern Life Indonesia Provider.
  • Conduct socialization on the procedure to hospitals/clinics.
  • Support Group Sales and Brokers related to the claim process.
  • Involve in Claim Projects or related operations.
  • Conduct quality checking/assurance of Claim Analysts, TPA, and other hospital provider services in alignment with company and departmental SOPs, guidelines, and regulatory requirements.
  • Coordinate with other departments to review and monitor claims, including claim data analytics and claim patterns for possible abuse/fraud claims.

Requirements:

  • Bachelor's degree from the Faculty of Medical.
  • 10 years' experience as Head of Claim.
  • Proven experience in managing end-to-end claim processes and leading transformation focusing on customer centricity to improve claim process effectiveness and customer experience.
  • Preferably experienced in a Joint Venture Life Insurance Company.
  • Strong understanding of life insurance terms and conditions and the claim appeal process.
  • Strong analytical skills, excellent communication, negotiation, and relationship-building skills.
  • Proven experience in claims strategy and leading claims transformation.
Seniority Level

Associate

Employment Type

Full-time

Job Function

Health Care Provider

Industries

Insurance

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