Claim Analyst

Company Description:

Rey.id is a technology-driven health and life insurance provider in Indonesia, offering a holistic approach to healthcare services and well-being. Unlike traditional insurance products, Rey focuses on quality healthcare services to improve the lives of its members. The company is committed to reimagining and democratizing life and health insurance to make it more desirable and beneficial.

Job Description:

• Review and verify claim documents to ensure completeness and accuracy such as verify and ensure completeness of claim documents, classify claim documents based on claim type and services, and identify incomplete or invalid documents and escalate when needed
• Validate AI-generated claim analysis results with supporting documents, from review and validate AI-generated claim analysis results, ensure accuracy of claim data such as diagnosis, cost, and service date
• Identify discrepancies, incomplete documents, or potential fraud cases
• Ensure claim processing complies with SOP and SLA
• Prepare and maintain claim reports and documentation
• Provide accurate claim-related information and support member inquiries
• Maintain confidentiality of member data and personal information

Requirement:

• Minimum Diploma/Bachelor’s degree in Nursing, Midwifery, Public Health, or related medical background
• Minimum 2 years of experience in a Health Insurance company
• Experience as a Claim Analyst in an insurance company would be an advantage
• Strong analytical thinking and problem-solving skills
• Detail-oriented with high accuracy in handling data and documents
• Familiar with claim verification and healthcare documentation
• Adaptable, quick learner, and comfortable working with technology/AI-assisted systems
• Proactive, initiative-driven, and able to work independently as well as collaboratively
• Good communication skills in handling internal coordination and member inquiries