Medical Claim Junior Officer
Blibli · Kota Jakarta Pusat
Sekilas tentang pekerjaan ini
Blibli mencari Medical Claim Junior Officer dengan latar belakang kesehatan yang kuat untuk menilai klaim medis dan mendukung kesejahteraan karyawan. Posisi ini berlokasi di Kota Jakarta Pusat dan ditujukan bagi kandidat dengan pengalaman relevan minimal 3 tahun.
Tugas utama
- Menilai klaim medis rawat jalan, rawat inap, gigi, dan optik.
- Memeriksa kelayakan klaim berdasarkan informasi medis dan kebijakan manfaat.
- Berkoordinasi dengan perusahaan asuransi, rumah sakit, dan penyedia layanan kesehatan.
- Memantau klaim tertunda serta menyelesaikan ketidaksesuaian dan klaim mencurigakan.
- Menganalisis tren klaim dan kebutuhan kesehatan karyawan untuk rekomendasi manfaat.
Kualifikasi utama
- Sarjana bidang kesehatan, keperawatan, farmasi, kesehatan masyarakat, kedokteran, atau bidang terkait.
- Minimal 3 tahun pengalaman di klaim medis, administrasi kesehatan, asuransi, atau manfaat medis.
- Pengetahuan kuat tentang penyakit, diagnosis, terminologi medis, pengobatan, dan prosedur kesehatan.
- Memahami proses asuransi kesehatan, penilaian klaim, regulasi, dan manfaat medis karyawan.
- Mampu menganalisis data menggunakan Microsoft Excel dan PowerPoint.
Ringkasan ini dibuat dengan AI dari deskripsi di bawah. Yang berlaku adalah deskripsi lengkapnya di situs Blibli.
Deskripsi pekerjaan
About the Role
Blibli is on a journey to build a highly effective, future-ready workplace where employee health and well-being are essential to creating a supportive and sustainable working environment.
As a Medical Claim Junior Officer, you will help ensure employees receive appropriate healthcare benefits through accurate medical claim assessments, effective coordination with healthcare providers, and timely resolution of medical-related issues.
We're looking for someone with a strong healthcare background and solid medical knowledge, who can understand diagnoses, interpret prescriptions, evaluate medical treatments, and navigate healthcare-related matters with confidence. Beyond claim administration, you'll contribute to improving employee healthcare experiences and supporting our broader employee well-being initiatives.
What You’ll Do
- Review and analyze employee medical claims, including outpatient, inpatient, dental, and optical benefits, by assessing diagnoses, prescriptions, medications, treatments, and supporting medical documents.
- Evaluate claim eligibility and accuracy based on medical information, insurance coverage, company benefit policies, and applicable guidelines.
- Coordinate with insurance companies, hospitals, and healthcare providers to manage claim administration, resolve medical-related issues, and maintain effective partnerships.
- Monitor pending claims, investigate discrepancies or suspicious claims, and ensure timely follow-up and resolution.
- Prepare and monitor medical claim payment requests, ensuring accurate documentation and timely settlement.
- Analyze healthcare utilization, medical claim trends, and employee health needs to provide recommendations for benefit improvements and employee well-being initiatives.
- Stay updated on healthcare developments, medical regulations, mental health, and employee well-being trends to support effective healthcare benefit management.
What You’ll Bring to the Team
- Bachelor's degree in Healthcare, Nursing, Pharmacy, Public Health, Medicine, or another health-related field.
- Minimum 3 years of relevant experience in Medical Claims, Healthcare Administration, Health Insurance, Medical Benefits, or a similar role.
- Strong medical knowledge, including understanding of diseases, diagnoses, medical terminology, treatments, and healthcare procedures.
- Ability to read and interpret doctors' prescriptions, medical notes, and supporting documents, with a good understanding of medications and their uses.
- Familiarity with health insurance processes, medical claim assessment, healthcare regulations, and employee medical benefits.
- Strong communication and coordination skills, particularly when dealing with insurance companies, hospitals, healthcare providers, and other external partners.
- Excellent attention to detail, analytical thinking, and investigative skills to identify claim discrepancies and assess medical information accurately.
- Strong foundational knowledge of data analysis, program management, and employee well-being initiatives, with the ability to process, analyze, and present data effectively using Microsoft Excel, PowerPoint, and other relevant tools.
Why You’ll Love Working Here
At Blibli, you'll have the opportunity to apply your healthcare expertise beyond traditional clinical settings and make a meaningful impact on employees' everyday well-being.
You'll work closely with healthcare partners, analyze medical trends, and help improve the way employees access and experience their healthcare benefits.
Join a collaborative Human Capital team where your medical knowledge and analytical skills can make a real difference as we continue growth — transforming together.
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