Claim Analyst

2 hours ago


Jakarta, Jakarta, Indonesia PT Maskapai Reasuransi Indonesia Tbk Full time

Role Description - Duties & Responsibilities:

  • Conduct claim analysis based on strong medical knowledge related to the claim process, including claim submission, review, and resolution, covering medical terminology, relevant medical codes, as well as understanding life insurance products, policy mechanisms, claim procedures, and applicable regulations.
  • Identify and resolve complex claim cases effectively throughout the claim process using data-driven analysis to determine appropriate solutions and make accurate decisions.
  • Perform communication and negotiation with ceding companies and retrocession partners to resolve claim disputes.
  • Build and maintain good working relationships with various stakeholders, both internal (within the company) and external parties (including ceding companies and other clients).

Qualifications

Position: Claim Analyst (Medical Background)

  • Minimum education: Bachelor's Degree (S1) in Medicine.
  • Strong medical knowledge, including:

  • Medical terminology

  • Medical diagnoses and procedures
  • Relevant medical coding systems
  • Good understanding of life insurance claim processes, including:

  • Claim submission

  • Claim review and resolution
  • Policy provisions and applicable regulations
  • Minimum 2 (two years of working experience, preferably in insurance claims, life insurance, or related fields.
  • Proven ability to analyze and resolve complex claim cases effectively using data-driven approaches.
  • Strong communication and negotiation skills, including coordination with ceding companies, retrocession partners, and other external parties.
  • Ability to build and maintain good working relationships with both internal and external stakeholders.
  • Proficient in Microsoft Office (Word, Excel, and PowerPoint).
  • Active English proficiency, both written and spoken.
  • Detail-oriented, and capable of making accurate decisions.

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