Medical Doctor

4 days ago

Jakarta, Jakarta, Indonesia PT. PRIMA SARANA JASA Full time 4,000,000 - 8,000,000 per year

WHAT YOU'LL BE DOING

  • Attend transmission and attend Case Quality Review in Operation Excellence every working day and duty day and give case directly to the best of his/her knowledge.
  • Assist daily activity in the Operation Excellence Department in obtaining sufficient medical reports from the medical providers to move the case forward.
  • Assist daily activity in the Operation Excellence Department to ensure reviewing medical reports from the medical providers are done promptly to fulfil the Turn Around Time (TAT).
  • Assist daily activity in the Operation Excellence Department in providing recommended medical providers for clients.
  • Assist daily activity in the Operation Excellence Department to negotiate with the medical provider for the best pricing, corporate price, or discount and to review the hospital billings whenever required.
  • Have a good relationship with the medical providers and ensure that the medical providers will provide the best quality of healthcare rendered by our clients.
  • Conduct billing audits of all received invoices before any payment to get the best review of medical claims.
  • Ensure all information related to the case activities is well documented in the system.
  • Ensure that all close cases/claims have the ICD-10 verified in the system.
  • Handle any complaints raised by clients or service providers towards the Operation Excellence Department.
  • Escalate to Medical Claim Excellence's Assistant Manager if the complaint is serious and needs further follow-up to mitigate service recovery.
  • Accountable for assisting other departments and crisis management centers with a special task or mission.
  • Maintain a good working environment, and develop good teamwork among colleagues and staff by maintaining good communication.
  • Ensure that all procedure, policy, and company information is maintained to the latest date issued by the Quality Control and Continuous Improvement of Company policy.
  • Establish a collaborative and cooperative relationship among the staff, to create a conducive working environment and conditions. To foster the motivation of the staff to work at optimal efficiency.

WHO WE ARE LOOKING FOR

  • Preferably 1-2 years working experience as a Medical Doctor/Medical Claim Analyst in TPA or Insurance Industry
  • Degree in Medicine.
  • Knowledge about Insurance, especially Health will be an advantage.
  • Possess a service-centred mindset.
  • Strong written and spoken English and Bahasa Indonesia

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