Health Claim Officer – Amica Sukses Mandiri

JagoKerja.com – Didirikan pada tahun 2018 oleh Cahya Martadinata dan Leony Soekarta yang telah berkecimpung di industri ini sejak tahun 2009, Amica melayani kebutuhan peserta asuransi kesehatan mulai dari bayi hingga usia senior.

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Deskripsi Pekerjaan :

1. Claims Document Verification: Conduct thorough reviews of submitted claim documentation, including medical records, invoices, and policy forms, to ensure accuracy and completeness. Verify the validity of claims against policy terms and conditions.
2. Healthcare Provider Liaison: Establish and maintain professional communication with hospitals, clinics, and other healthcare providers to obtain necessary medical information and clarify treatment details.
3. Guarantee of Payment (GOP) Administration: Manage the processing of GOP requests, coordinating with relevant departments and healthcare providers to facilitate timely issuance. Monitor GOP status and address any related issues.
4. Claims Processing and Adjudication: Process claims in accordance with established service level agreements (SLAs), calculating benefits and preparing settlement reports. Address claim-related inquiries and disputes from policyholders and healthcare providers.
5. Compliance and Reporting: Ensure compliance with all applicable regulations and internal policies. Maintain accurate and confidential records of claim activities. Generate regular reports on claim processing performance.

Kualifikasi :

1. Bachelor’s degree in a relevant field (e.g., healthcare administration, insurance, finance).
2. Have experience in claims processing within the insurance or healthcare industry.
3. Comprehensive understanding of medical terminology and billing procedures.
4. Good written and verbal English communication skills.
5. Strong analytical and problem-solving abilities.
6. Meticulous attention to detail and accuracy. 
7. Ability to work effectively under pressure and meet deadlines.
8. Strong organizational and time-management skills.

Key Competencies :

1. Medical Documentation Analysis
2. Provider Relationship Management
3. Regulatory Compliance
4. Data Management
5. Problem Resolution
6. Effective Communication

Keterangan & Catatan

Kunjungi Instagram Kami :

@lokerjakarta.info1, @lokerlampung.info_, @loker.tanggerang.info_

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