Deskripsi pekerjaan
Key Responsibilities: Implement strategic quality control measures both individual and group to ensure cost-effective healthcare delivery without compromising patient care. Evaluate new and renewing healthcare providers, assess hospital classifications, and analyze tariff structures to optimize provider networks and cost-efficiency.Offer expert insights on complex medical cases concerning medical necessity, benefit coverage, and policy exclusions to support product development and claims adjudication. Continuously review and update medical guidelines and insurance practices to align with current clinical standards and ensure operational excellence. Conduct ongoing research and analysis to develop and maintain evidence-based medical guidelines and clinical pathways, enhancing care quality and consistency.
Kualifikasi: General Practitioner doctor (Dokter Umum); Min experience 1 years as a claim analyst or supervisor or more; Meticulous attention to detail to ensure accuracy and compliance; Provide non-biased, medical perspectives and point of view; Strong skills to solve complex medical issues.
Kualifikasi
- General Practitioner doctor (Dokter Umum)
- Min experience 1 years as a claim analyst or supervisor or more
- Meticulous attention to detail to ensure accuracy and compliance
- Provide non-biased, medical perspectives and point of view
- Strong skills to solve complex medical issues
Informasi lowongan
- Tipe pekerjaan
- Contract
- Gaji
- Rp 8.900.000 – Rp 9.000.000 per month