Cashless Health Claim

3 days ago

Jakarta, Jakarta, Indonesia PT Prudential Life Assurance Full time 6,000,000 - 8,000,000 per year

Principle Duties & Responsibilities:

  • To manage team.
  • To monitor and to ensure that that following processes in the team are in place, made 100% accurate and according to agreed SLA.
  • To give advice regarding policy provision on guarantee cashless claim cases when consulted by team members.
  • To give training and feedback regarding guaranteed cases/updates from another department to assessor team.
  • To manage and ensure that the team is manned efficiently by carefully proposing shifts and schedules to the Assistant Manager and by closely monitoring attendance schedule.
  • To ensure that the function adheres to policy conditions, by performing quality assurance in his/ her team activities and by giving regular coaching.
  • To ensure that his/ her team are efficient and sufficiently manned, by performing workload and staffing balance in his/ her team every day.
  • To ensure that problem prompts escalation to supervisor is real time, by giving prompt response to an escalation.
  • To do regular reporting to supervisor in a timely manner
  • To maintain clear communication and warm relationships to all related parties.
  • To give a decision on approving / disapproving preauthorization requests and discharge planning requests or case monitoring approval requests or claim settlement requests.
  • To ensure that all communications with customers, agents, partners, and other department staffs are made politely and correctly.

Job Specification:

  • Qualification

  • S1 (Bachelor degree)

  • Experience

  • 2 years working experience

  • 1-year relevant experience (Preauthorization process, Discharge planning, Case Monitoring and Cashless Claim Process).

  • Knowledge

  • Good understanding of preauthorization process or discharge planning or case monitoring or cashless claim process.

  • Familiar with all processes within preauthorization, discharge planning, case monitoring and cashless claim settlement.

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