Health Insurance Claim Head

Company Description Cermati is a financial technology (fintech) startup based in Indonesia. Cermati simplifies the process of finding and applying for financial product by bringing everything online so people can shop around for financial products online and can apply online without having to physically visit a bank.

Our team hailed from Silicon Valley Tech companies such as Google, Microsoft, LinkedIn and Sofi as well as Indonesian startups such as Doku, Touchten. We have graduates from well known universities such as Universitas Indonesia, ITB, Stanford, University of Washington, Cornell and many others. We are building a company with the same culture of openness, transparency, drive and meritocracy as Silicon Valley companies. Join us in our cause to build a world class fintech company in Indonesia.

Job Description

Lead the Employee Benefit Insurance After Sale team including Data and Claim team

Responsibilities of After Sale team include processing claims, assist clients with endorsements, documents and data keeping

Oversees insurance claims that are in progress to make sure claim decision come out according to SLA and claim appraisal result is justified according to the agreed TC

Assist clients who are admitted to hospital by coordinating with insurance and hospitals when necessary

Make daily, weekly, and monthly report for claim updates

Customer care helpline – 24 hours

Develop and maintain relationships with insurance companies’ claim departments

Negotiate and appeal rejected claims with insurance

Monitor endorsement process and make sure SLA is achieved

Check and make sure member cards are correct and send them to the clients on time

Assist with client closing process by coordinating with insurance and making sure the policy T and C is as per agreed

Put in place control mechanisms that enable achievement of high levels of customer satisfaction.

Ensure quality and service excellence to clients and 5/5 client satisfaction

Continuously improve current systems and processes

Promote a culture of high performance and continuous improvement that values learning and commitment to quality.

Qualifications

More than 5 years experience as Claim Manager in insurance or brokerage firms

Have good relationships with insurance companies

Excellent in communication, negotiation, and persuasion skills

Strong adherence to SLA and maintaining clients expectations

Able to respond to clients inquiry with lightning speed and accuracy

Strong understanding of insurance terms and conditions and claim appeal process

Background in medicine is preferred but not a must

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