Job Description
Join the dynamic team at Central Asia Raya Life Insurance as a Claim Analyst. We are looking for a detail-oriented professional to ensure the accuracy, fairness, and efficiency of our health insurance claim processes. In this role, you will be the backbone of our policyholder support, ensuring that health claims are evaluated with precision and integrity while adhering to company policies and medical standards.
You will work in a fast-paced environment where your analytical skills will directly impact customer satisfaction and company financial health. We value individuals who are proactive, communicate effectively, and possess a deep understanding of medical terminology and insurance coverage terms. If you are passionate about the insurance industry and eager to contribute to a growing team, we would love to hear from you.
Responsibilities
- Evaluate and process health insurance claims by verifying policy coverage, medical necessity, and eligibility.
- Analyze medical records, doctor reports, and invoices to detect inconsistencies or potential fraud.
- Coordinate with healthcare providers, hospitals, and internal departments to clarify claim details.
- Ensure all claim adjudications are completed within defined Service Level Agreements (SLAs).
- Maintain accurate and detailed documentation of the claim evaluation process in the insurance database.
- Respond to inquiries from policyholders regarding claim status and coverage explanations with professionalism.
- Identify and escalate complex or high-risk claims to the management team for further review.
Qualifications
- Bachelor’s degree in Nursing, Public Health, Pharmacy, or a related field (preferable).
- Minimum 1-2 years of experience in health insurance claims, medical billing, or a clinical hospital setting.
- Strong understanding of health insurance regulations and medical terminology.
- Proficiency in Microsoft Office Suite, particularly Excel, for data tracking and reporting.
- Strong analytical mindset with a keen eye for detail and data integrity.
- Excellent verbal and written communication skills in Indonesian and English.
- Ability to work independently and manage high volumes of claims accurately under deadlines.