Assistant Manager Claim Quality Control & Anti fraud

🙌🏻 About Us

PT Administrasi Medika or widely known as AdMedika is established in 2002, and became part of Telkom Group under Telkom Indonesia’s subsidiary holding company, PT Multimedia Nusantara (TelkomMetra) in 2010. As a part of Telkom Group, AdMedika is fully supported by Telkom Indonesia and its subsidiaries with maximum group synergy and optimal collaboration through Telkom Group Shared Solution to deliver only the best services and solutions to its partners and clients. AdMedika servers millions of members with a comprehensive range of services that includes Healthcare Claim Management services, Healthcare Information Systems and Emergency Assistance services. As a technology based company, our services are always backed with state-of-the-art technology. Our EDC infrastructure network spreads through thousands of healthcare providers accross Indonesia and neighboring countries. AdMedika’s clientele comprise of top insurance companies in the nation, self-healthcare-managed corporations, TPA companies, and state-own companies (BUMN). Be a part of the nation's most preferred healthcare partner and you can rest assure that you are in good hands. Vision Be the biggest healthcare solution provider in the region Mission Lead Indonesian digital healthcare integrated solution and platform Objective BELIEVE : Boost revenue, Ebitda minded, Lead market, Increasing net income, Telkom Group SynErgy, Value our people, Service excellencE 

💰 Salary

Very competitive

👑 Job Role

• Memonitor serta mengontrol kualitas layanan care / claim
• Memonitor serta memeriksa pengelolaan data dan menganalisa claim/care
• Memberikan rekomendasi layanan berdasarkan data di lapangan
• Memonitor laporan serta memeriksa terkait dengan hasil pengecekan claim/care
• Menganalisa semua aspek pelaporan fraud perusahaan
• Mengidentifikasi data system berkaitandengan kebutuhan analisis data rawat inap, rawat jalan dan/atau kebutuhan analisis unit anti fraud
• Memonitor kriteria fraud, finding data suspicious, dan data statistik rawat inap dan rawat jalan sesuai dengan literature dan/atau peraturan yang berlaku
• Memonitor laporan mengenai seluruh report fraud yang telah dianalisis dan menginformasikannya ke atasan langsung.
• Menganalisa, validasi data, edukasi dan/atau berkoordinasi dengan unit lain dalam menjaga validitas data.
• Memonitor proses mengenai tindak lanjut alert untuk suspicious atas member,dokter, dan provider

⛩️ Requirements

• Di utamakan pendidikan S1 kedokteran
• Minimal Pengalaman 4 tahun di bidang yang sama 
• Memiliki kemampuan Menganalisa & fraud terkait klaim
• Memiliki Kemampuan komunikasi yang baik
• Memiliki kemampuan Microsoft Office yang baik
• Kemampuan bahasa Inggris yang baik

🎁 Perks

• THR / Bonus system