Head of EB Claim

21 hours ago

Jakarta, Jakarta, Indonesia Easy Sunday Full time

As Head of Claim EB each day, you'll be…

  • Manage the end-to-end claims operations including inpatient, outpatient, and dental claims.
  • Develop and implement claims policies, procedures, and service standards in line with company objectives and OJK regulations.
  • Ensure timely, accurate, and compliant claims settlement in accordance with policy terms and SLAs.
  • Monitor claims ratio, utilization trends, and fraud indicators; recommend strategic improvements.
  • Oversee fraud detection, investigation, and recovery processes.
  • Review and approve high-value, complex, and disputed claims.
  • Prepare and present claims performance reports, loss ratio analysis, and operational dashboards to Management.
  • Lead digital transformation initiatives related to claims systems, auto-adjudication, and straight-through processing.
  • Leading teams in Claim Health Unit, CR Unit, and CS-CMT Unit.

What we would like you to have…

  • Bachelor's degree in Medical Doctor.
  • Professional insurance certifications (AAK or equivalent) are a strong advantage.
  • Have min. 8 years experience in Health and Medical Claims (Insurance industry).
  • Strong knowledge of EB products, OJK regulations, and medical claims process.
  • Strong leadership, analytical, and communication skills.
  • Good fluency in English.

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