Deskripsi Pekerjaan
Are you a Medical Doctor looking to pivot your career into the dynamic field of healthcare administration and insurance? Rumah Sakit Pondok Indah Group, a leader in premium healthcare services, is seeking a meticulous and analytical Medical Claim Analyst to join our team in Jakarta Selatan.
In this non-clinical role, you will be the bridge between medical services and financial administration. You will play a critical role in ensuring the accuracy, validity, and compliance of medical claims. This is an exceptional opportunity for a physician to utilize their clinical knowledge in a corporate environment, contributing to operational excellence and financial sustainability within a world-class hospital group.
We are looking for a professional with a sharp eye for detail, a strong understanding of medical coding and terminology, and the ability to navigate complex insurance policies. If you are ready to transition away from patient-facing duties while remaining at the heart of the healthcare industry, we invite you to apply today.
Tanggung Jawab
- Review and analyze medical claims to ensure accuracy and adherence to hospital billing policies and insurance provider guidelines.
- Verify clinical diagnosis, procedures, and medical necessity against patient medical records.
- Coordinate with internal clinical departments to resolve discrepancies in medical documentation.
- Evaluate claim approvals and rejections based on policy coverage and clinical standards.
- Maintain comprehensive logs of processed claims and provide regular reports to the management team.
- Ensure compliance with healthcare regulations and internal quality standards during the claims verification process.
- Participate in periodic audits to improve the efficiency and accuracy of the medical claim cycle.
Kualifikasi
- Must hold a professional degree in Medicine (Dokter Umum) from an accredited university.
- Possess a valid and active STR (Surat Tanda Registrasi).
- Minimum 1-2 years of clinical experience; exposure to insurance or hospital administration is highly preferred.
- Strong analytical and problem-solving skills with a high degree of accuracy.
- Excellent knowledge of medical terminology, ICD-10, and health insurance claim procedures.
- Proficient in using Microsoft Office Suite (Excel, Word) and Hospital Information Systems (HIS).
- Ability to work independently and manage time effectively under tight deadlines.
- Strong communication skills in both Indonesian and English.