Job description for Medical Advisor Asuransi Kesehatan at PT Nata Praja Solusindo
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.
Qualification:
- 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
