Head of EB Claim (Health & Medical)

Join to apply for the

Head of EB Claim (Health & Medical)

role at

Sunday

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.

Lead 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.

Referrals increase your chances of interviewing at Sunday by 2x

Get notified about new Head of Insurance jobs in

Jakarta Metropolitan Area .

Seniority level Director

Employment type Full-time

Job function Sales and Business Development

Industries Insurance

#J-18808-Ljbffr