- Responsible for the process of risk claims, including individual, group and provider claims and provide claim decisions according to the value of the Authorization. As well as reporting and analyzing the impact on the company
- Coordinating process governance, decision making and reporting of risk claims, ensuring that the Company has carried out its risk claim payment obligations according to the agreement and supports the company's good reputation going forward
- Make an analysis of the risk claim process, achieve the target claim process and propose changes to the claim process so that it is better in the future
- Collaborate with the Customer Service Department in conveying an explanation of the claim and settlement process if there are problems from the Customer and or third parties including settlement in the form of Exgratia
- Make a list of risks that will occur in each section, to ensure risk mapping can be carried out and can avoid risks that will occur
- Coordinate with the Underwriting Department in providing recommendations for policy renewal and termination based on the customer's claim history
Qualifications :
- S1 of Medicine, Public Health, Nursing
- Minimum 5 years of working experience in the area of Claim Assistant Manager / Manager
- Having experience in insurance industry is a must
- Having certification of General Practitioner, AAMAI or PAMJAKI would be an advantage