As Head of Claim EB each day, you'll be…
- Manage the end-to-end claims operations including inpatient, outpatient, and dental claims.
- Develop and implement claims policies, procedures, and service standards in line with company objectives and OJK regulations.
- Ensure timely, accurate, and compliant claims settlement in accordance with policy terms and SLAs.
- Monitor claims ratio, utilization trends, and fraud indicators; recommend strategic improvements.
- Oversee fraud detection, investigation, and recovery processes.
- Review and approve high-value, complex, and disputed claims.
- Prepare and present claims performance reports, loss ratio analysis, and operational dashboards to Management.
- Lead digital transformation initiatives related to claims systems, auto-adjudication, and straight-through processing.
- Leading teams in Claim Health Unit, CR Unit, and CS-CMT Unit.
What we would like you to have…
- Bachelor’s degree in Medical Doctor.
- Professional insurance certifications (AAK or equivalent) are a strong advantage.
- Have min. 8 years experience in Health and Medical Claims (Insurance industry).
- Strong knowledge of EB products, OJK regulations, and medical claims process.
- Strong leadership, analytical, and communication skills.
- Good fluency in English.