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Head of Claim (Great Eastern Life Indonesia)

Salary undisclosed

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Job Description:

  • Monitor and Ensure claim process within agreed TAT , policies & procedures, Company Regulation/ Needs
  • Make decision claim payment - within authority limit
  • Ensure all Reports related to claim including the analysis submit within agreed dateline & Claim procedures
  • Check claim guidelines and procedures in Claim and Provider Relation
  • Monitor and provide response regarding complaint related to Claim
  • Monitor and Ensure TPA (Third Party Administrator) process accordingly with agreed agreement; and, support TPA for assuring decisions on coverage & GL
  • Support the policy wording development & revamp
  • Visit hospital/clinic to offer cooperation as Great Eastern Life Indonesia Provider
  • Conduct socialization on the procedure to Hospital/Clinic
  • Support Group Sales and Broker related to claim process
  • Involve in Claim Project or related Operation
  • Conduct Quality Checking/ Assurance of Claim Analyst and/or TPA and/or Other Hospital Provider Services and/or Assessment that aligned with Company's / Dept SOP, Guidelines and Regulatory Requirements.
  • Coordinate with other Department’s Team to review & Monitor Claim include Claim Data Analytic, Claim Pattern (for possible Abuse/ Fraud Claim, etc)

Requirements:

  • Bachelor’s degree from Faculty of Medical
  • 10 years’ experience as Head of Claim
  • Proven experience in managing end-to-end claim processes and leading transformation focusing on customer centricity to improve claim process effectiveness and customer experience.
  • Preferably, experienced in Joint Venture Life Insurance Company
  • Strong understanding of life insurance terms and conditions and claim appeal process.
  • Strong analytical skills, Excellent communication, negotiation, and relationship building skill
  • Proven experience in claims strategy and leading claims transformation.