job description
Join Cooperative Health Management Federation as an Insurance Claims Specialist in beautiful Bali! In this pivotal role, you will ensure seamless processing of insurance claims by meticulously verifying policyholder eligibility, coverage details, and supporting documentation. Your expertise will drive timely resolutions while fostering strong collaboration with stakeholders, including policyholders, healthcare providers, and internal teams.
This is a unique opportunity to contribute to a mission-driven organization in a dynamic, tropical work environment. Ideal for detail-oriented professionals with a passion for accuracy and customer service, this position offers a competitive salary, career growth, and the chance to live and work in one of the worldâs most sought-after destinations.
If you thrive in a structured yet fast-paced setting and are committed to delivering excellence in claims management, we invite you to apply today!
Responsibility
- Review and validate insurance claims for accuracy, completeness, and compliance with policy terms.
- Verify policyholder eligibility, coverage limits, and exclusions to ensure proper claim adjudication.
- Coordinate with healthcare providers, policyholders, and internal departments to resolve discrepancies or missing documentation.
- Process approved claims efficiently while maintaining strict confidentiality and data security standards.
- Document all claim activities, decisions, and communications in the companyâs claims management system.
- Identify and report potential fraud or irregularities in claims submissions.
- Provide clear, professional communication to stakeholders regarding claim status, requirements, or denials.
- Stay updated on industry regulations, company policies, and best practices in claims processing.
Qualifications
- Bachelorâs degree in Business Administration, Finance, Healthcare Management, or a related field.
- Minimum of 2 years of experience in insurance claims processing, healthcare administration, or a similar role.
- Strong understanding of insurance policies, coverage types, and claims workflows.
- Exceptional attention to detail and analytical skills to assess complex claim scenarios.
- Excellent written and verbal communication skills in English.
- Proficiency in claims management software and Microsoft Office Suite (Excel, Word).
- Ability to work independently, meet deadlines, and manage multiple priorities in a fast-paced environment.
- High ethical standards and commitment to maintaining confidentiality of sensitive information.