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PT Reycom Document Solusi (RDS Group)

4 day(s) ago

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Claim Analyst Reimbursement Senior

Experience Staff

Full-Time

DKI Jakarta, Kota Jakarta Selatan
Working Mode : WFO

Job Responsibilities

  • Analyze and process health insurance reimbursement claims, primarily inpatient claims.
  • Review medical documents, diagnosis, treatment, and claim documents to assess eligibility and accuracy.
  • Validate claims against policy benefits, coverage, exclusions, and applicable terms & conditions.
  • Handle reimbursement claims for both corporate and individual members.
  • Manage and resolve complex claim cases, including discrepancies and potential irregularities.
  • Coordinate with members, corporate PICs, healthcare providers, agents, and internal teams when required.
  • Ensure accurate and timely claim processing in accordance with SLA/TAT and company procedures.
  • Support claim billing, reporting, and documentation processes.
  • Identify opportunities for claim process improvement and provide recommendations.

Job Requirements

  • Minimum Bachelor's degree in Nursing.
  • Minimum 3 years of experience in Health/Reimbursement Claims, preferably with inpatient reimbursement experience.
  • Strong understanding of medical documents, claim analysis, and policy benefits.
  • Strong analytical, problem-solving, communication, and attention-to-detail skills.
  • Able to work independently and collaborate effectively with multiple stakeholders.

Required Skills

Spoken Skills

Written Skills