Claim Handler (Health) - Zurich Asuransi Indonesia

Job Summary

Investigate, evaluate and conclude low complexity personal or commercial line claims by following established protocols to ensure that claims are handled in the most effective, efficient way while delivering a customer-centric claims service.

Job Qualifications

• Min. S1 Nurse/Midwife/Pharmacy or others in Medical Science/Practice.
• Min. 3 Years' experience in Health Claim.
• Capable to analyze Health Claim, Communication skills, Operate Ms. Word & Ms. Excell.

Job Accountabilities - Key Accountabilities

• Capture and update claims data/information in compliance with best practices for low complexity, low exposure to personal or commercial line claims.
• Determine liability by gathering facts.Confirm policy existence by identifying coverage on claims.
• Work to have a timely resolution to claims.
• Establish timely reserves within authority limit and assess damages.
• Ensure customer service by proactively communicating information, responding to inquiries and following customer protocols.
• Manage expenses by working within vendor approved networks and managing the scope of work assigned to outside contractors.
• Ensure legal compliance by following laws and regulations and internal control requirements.
• Refer claim to subrogation and fraud teams as needed.
• Protect Zurich's reputation by keeping claims information confidential.
• Understand the current with industry trends and establish personal networks and participate in professional societies.
• Contribute to the team results and participating in projects as needed.
• Follow established claims handling procedures to ensure consistency and quality in claims services.
• Aligned to the organization's Claims Vendor Management strategy.
• Seek assistance from colleagues for more complex issues, to ensure quality and promote continuous learning.
• Provide feedback on business processes and systems to identify opportunities for improvements.