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Aetna is now a CVS Health Company

Claim Benefit Specialist (Assessor / Analyst), Indonesia - Multiple roles open

Primary Location: Jakarta, IDN
Additional Locations: IDN-Jakarta

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.

Family Summary/Mission

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.

Position Summary/Mission

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

Additional Information
  • 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

Click To Review Our Benefits (PDF)


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