Deskripsi Pekerjaan
Are you a detail-oriented professional with a passion for insurance operations? Prudential Group, a global leader in life insurance and financial services, is looking for a dedicated Claim Analyst to join our high-performing team in Jakarta. In this role, you will play a critical part in maintaining our commitment to our customers by ensuring the accuracy, fairness, and efficiency of our hospitalization claim processes.
You will serve as a key decision-maker in evaluating medical claims, identifying potential irregularities, and ensuring compliance with policy terms and conditions. We are looking for someone who combines analytical rigor with strong empathy, as you will be responsible for handling sensitive information and helping our policyholders during their time of need. If you thrive in a fast-paced environment and have a keen eye for detail, we invite you to grow your career with a world-class organization.
Tanggung Jawab
- Review and analyze complex hospitalization claims in accordance with policy provisions and company guidelines.
- Verify medical documentation, diagnosis codes, and hospital billing statements for accuracy and legitimacy.
- Communicate effectively with healthcare providers, policyholders, and internal stakeholders to resolve claim discrepancies.
- Identify potential fraudulent activities and escalate suspicious claims for further investigation.
- Maintain high levels of data integrity within the claims management system.
- Ensure all claims are processed within the established Service Level Agreements (SLAs).
- Prepare detailed reports on claim trends and provide feedback to improve the adjudication process.
Kualifikasi
- Bachelor’s degree in Nursing, Public Health, Pharmacy, or a related field (or equivalent professional experience).
- Minimum 2 years of experience in medical claim analysis, hospital billing, or insurance operations.
- Strong understanding of medical terminology, ICD-10 coding, and hospital billing procedures.
- Proficiency in Microsoft Office Suite, particularly Excel, for data analysis and reporting.
- Excellent analytical, problem-solving, and decision-making skills.
- Ability to manage a high volume of work with strict attention to detail and accuracy.
- Fluency in Bahasa Indonesia and professional proficiency in English.