Claims Analyst - Indonesia

Claim Analyst StaffQualifications:Male/ FemaleMinimum 1-year experience as a Claim Analyst in Insurance/ TPA companyExcellent knowledge health insurance policy, health claims procedures and terminologyExcellent knowledge on medical terminologiesStrong analytical and inter-personal skillGood problem-solving skillProficient in Ms. OfficeResponsible, ability to work individually as well as with a teamGood interpersonal, communication, attitude and positive**Responsibilities**:- Make medical necessity and medical appropriateness determinations for health and dental claims.- Determine benefit liabilities based on medical necessity, benefit level, member eligibility, waiting periods, pre-existing conditions, exclusions and coverage.- Ensure all claims are properly documented and conform to company's workflow and documentation requirements.- Ensure claims are associated with and comply with any prior-authorization or authorization requirement.- Coordinate with the medical review team for questions regarding medical necessity and medical appropriateness.- Research and resolve misapplied claim payments or provider reimbursements.- Ensure claims are properly coded and documented before processing.- Document and report potentially fraudulent provider and member claims to immediate supervisor or manager.- Submit all approved and processed claims to finance team for liquidation.- Issue EOB (explanation of benefits) to all members as well as EOP (explanation of provider payments) to all network providers.- Complete all daily, weekly, monthly, quarterly and annual management reporting requirements for the scope of responsibilities associated with your position.- Communication to providers and members for partially denied, incomplete or denied claims.- Ensuring all company service level standards are met as it relates to claims analysis and examination.- Other tasks assigned by management in support of the company's claims management objectives**Benefits**:- Salary IDR4,900,000- BPJS Ketenagakerjaan- BPJS Kesehatan- Religious BonusPay: Rp4,000,000 - Rp4,900,000 per month