Claim Investigation Senior Officer

Job description:

• Responsible for managing anti-fraud strategy.

• Identification and analysis of irregular claims.

• Investigate suspicious claim on potential fraud cases.

• Analysis of processing cost containment of claim guarantee.

• Document the results of anti fraud-Investigator properly.

• Perform valuations and compile fraud investigations report.

• Participate in developing system to improve better control anti-fraud system.

Job qualification:

• Bachelor’s Degree in Nursing, Midwifery or other healthcare-related fields.

• 1–2 years of experience in claim investigation or a related healthcare insurance role.

• Strong understanding of medical terminology, clinical procedures, and treatment protocols.

• Experience in reviewing medical records and assessing the validity of health or life insurance claims.

• Good communication skills, with the ability to collaborate effectively with hospitals, clinics, and internal teams.

• Familiarity with healthcare regulations and insurance claim standards.

• Fluent in English, both oral and written.

• Strong analytical skills, dynamic, energetic and results driven.

• Willing to be located in our Head Office at Menara Matahari, Lippo Karawaci, Tangerang, Banten.

• Experience in handling sensitive and confidential information with high integrity and professionalism.

Disclaimer:

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