Claim Analyst Reimbursement Senior

Job Description:

• Analyze and process health insurance reimbursement claims, primarily inpatient claims.
• Review medical documents, diagnosis, treatment, and claim documents to assess eligibility and accuracy.
• Validate claims against policy benefits, coverage, exclusions, and applicable terms & conditions.
• Handle reimbursement claims for both corporate and individual members.
• Manage and resolve complex claim cases, including discrepancies and potential irregularities.
• Coordinate with members, corporate PICs, healthcare providers, agents, and internal teams when required.
• Ensure accurate and timely claim processing in accordance with SLA/TAT and company procedures.
• Support claim billing, reporting, and documentation processes.
• Identify opportunities for claim process improvement and provide recommendations.

Kualifikasi

Requirements:

• Minimum Bachelor's degree in Nursing.
• Minimum 3 years of experience in Health/Reimbursement Claims, preferably with inpatient reimbursement experience.
• Strong understanding of medical documents, claim analysis, and policy benefits.
• Strong analytical, problem-solving, communication, and attention-to-detail skills.
• Able to work independently and collaborate effectively with multiple stakeholders.