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Claims Analyst

2 weeks ago

Jakarta, Indonesia Inova Care International Full time

Claim Analyst Staff

Qualifications:
Male/ Female

Minimum 1-year experience as a Claim Analyst in Insurance/ TPA company

Excellent knowledge health insurance policy, health claims procedures and terminology

Excellent knowledge on medical terminologies

Strong analytical and inter-personal skill

Good problem-solving skill

Proficient in Ms. Office

Responsible, ability to work individually as well as with a team

Good interpersonal, communication, attitude and positive

**Responsibilities**:

- Make medical necessity and medical appropriateness determinations for health and dental claims.
- Determine benefit liabilities based on medical necessity, benefit level, member eligibility, waiting periods, pre-existing conditions, exclusions and coverage.
- Ensure all claims are properly documented and conform to company’s workflow and documentation requirements.
- Ensure claims are associated with and comply with any prior-authorization or authorization requirement.
- Coordinate with the medical review team for questions regarding medical necessity and medical appropriateness.
- Research and resolve misapplied claim payments or provider reimbursements.
- Ensure claims are properly coded and documented before processing.
- Document and report potentially fraudulent provider and member claims to immediate supervisor or manager.
- Submit all approved and processed claims to finance team for liquidation.
- Issue EOB (explanation of benefits) to all members as well as EOP (explanation of provider payments) to all network providers.
- Complete all daily, weekly, monthly, quarterly and annual management reporting requirements for the scope of responsibilities associated with your position.
- Communication to providers and members for partially denied, incomplete or denied claims.
- Ensuring all company service level standards are met as it relates to claims analysis and examination.
- Other tasks assigned by management in support of the company’s claims management objectives

**Benefits**:

- Salary IDR4,900,000
- BPJS Ketenagakerjaan
- BPJS Kesehatan
- Religious Bonus

Pay: Rp4,000,000 - Rp4,900,000 per month