Key Responsibilities:
- Oversee case management and guarantee letters (GL) to ensure SLA/TAT compliance.
- Provide medical support to case management and claims teams.
- Review medical necessity, treatment plans, and billing for cost containment.
- Liaise with providers, clients, and internal teams on medical escalations.
- Ensure clinical quality, support training, and contribute to process improvements.
- Lead medical-related issue resolution and service enhancements.
Qualifications:
- Medical Doctor (MD) with valid STR & SIP (Indonesia).
- Min. 2 years' experience in health insurance, TPA, hospital utilization, or case management.
- Strong knowledge of clinical pathways, treatment protocols, and insurance policies.
- Excellent communication, analytical, and problem-solving skills.
- Willing to be on-call for urgent/critical cases.