Head of EB Claim (Health & Medical)

As Head of Claim EB each day, you'll be…

Manage the end-to-end claims operations including inpatient, outpatient, and dental claims.

Develop and implement claims policies, procedures, and service standards in line with company objectives and OJK regulations.

Ensure timely, accurate, and compliant claims settlement in accordance with policy terms and SLAs.

Monitor claims ratio, utilization trends, and fraud indicators; recommend strategic improvements.

Oversee fraud detection, investigation, and recovery processes.

Review and approve high-value, complex, and disputed claims.

Prepare and present claims performance reports, loss ratio analysis, and operational dashboards to Management.

Lead digital transformation initiatives related to claims systems, auto-adjudication, and straight-through processing.

Leading teams in Claim Health Unit, CR Unit, and CS-CMT Unit.

What we would like you to have…

Bachelor’s degree in

Medical Doctor.

Professional insurance certifications (AAK or equivalent) are a strong advantage.

Have min.

8 years

experience in

Health and Medical Claims (Insurance industry).

Strong knowledge of EB products, OJK regulations, and medical claims process.

Strong leadership, analytical, and communication skills.

Good fluency in English.

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