Claim Benefit Specialist (Assessor / Analyst), Indonesia - Multiple roles openPrimary Location: Jakarta, IDN
Additional Locations: IDN-Jakarta Apply
Job Group Summary
Fast, accurate claims payment is one of the ways we make a difference in people's lives. Claims professionals work directly with members, doctors and employer groups, providing a friendly and knowledgeable voice at the other end of the phone at times when it's most needed.
Achieve superior claim and member service performance through an integrated process of operational, quality, medical cost, and resource management meeting and/or exceeding member, plan sponsor, and provider expectations.
Reviews and adjudicates claims in accordance with claim processing guidelines
Fundamental Components & Physical Requirements
- Analyzes and approves claims.
- Completes work with a limited degree of supervision.
- Assesses claims up to given Authority limit-lower $ value claims and advice from designated Specialists. (Senior Claim Benefits Specialist and Medical Claim Benefits Specialist colleagues).
- Proofs claim or referral submission to determine, review, or apply appropriate guidelines, coding, member identification processes, provider selection processes, claim coding, including procedure, diagnosis and pre-coding requirements.
- Investigate claims for possible abuse and fraud. Conducts outreach activities including but not limited to email, member calls, provider calls as part of the claim’s adjudication process.
- In accordance with prescribed operational guidelines, manages claims on desk, route/queues, and all systems within specified turn-around-time parameters.
- Utilizes all applicable system functions available ensuring accurate and timely claim processing service (i.e., use of all documented resources).
- Escalate unresolved claims complaints and high costs claims to the claim’s supervisor for guidance.
- Continually work to improve best practices procedures and standards.
- Ensures compliance with requirements of regional compliance authority/industry regulator.
- Adheres to international privacy policies, practices and procedures.
Education and Certification
Diploma or bachelor’s degree
- Computer literacy
- Excellent communication skills (English & Thai languages)
- Understanding of medical terminology
- Oral and written communication skills
- Ability to maintain accuracy and production standards
- Technical skills
- Analytical skills
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