Health Benefit Officer

Responsible for administering employee health benefits, processing medical claims, coordinating with hospitals and insurance providers, and ensuring all processes comply with company policies.

Verify employee health claim documents to ensure all required information and documents are complete.

Ensure claims comply with company benefit provisions, insurance policies, and BPJS requirements.

Input and monitor claim data to maintain accurate and up-to-date health benefit records.

Monitor claim settlement progress to ensure claims are processed and paid in a timely manner.

Create report and analysis of healthcare costs to help identify irregularities or unusual claim patterns.

Communicate with hospitals, clinics, insurance companies, and BPJS to support smooth processing of employee healthcare claims and services.

Follow up and resolve any claim discrepancies to support accurate claim settlement.

Create supporting documents for inpatient guarantee (GL / Guarantee Letter) to support employee hospitalization processes.

Provide information on health benefits to help employees understand coverage limits, exclusions, and claim procedures.

Handle employee inquiries and complaints to ensure responsive and professional health benefit support.

Support BPJS health administration processes.

Prepare routine reports on healthcare costs, claim trends, and benefit utilization to support monitoring and analysis.

Maintain data accuracy and confidentiality to protect sensitive medical and employee information.

Manage claim documents and archives to ensure compliance with procedure and audit standards.

Bachelor’s Degree (S1) in Hospital Administration or Health Service Management.

Minimum 3 years of experience in related fields.

Understanding of health insurance policies, BPJS Health, and company benefit schemes is a must.

Knowledge of claim procedures, benefit limits, medical exclusions, and pre-existing condition rules.

Basic understanding of medical terminology (diagnosis, procedures, medications).

Ability to use claim systems, HRIS, and Excel (VLOOKUP, pivot tables, etc.).

Familiarity with common medical terms (ICD-10 diagnoses, medical procedures, medications).

Ability to read basic medical documents such as medical summaries, lab results, or prescriptions.

Disciplined, detail-oriented, and able to maintain strict confidentiality of health information.

Strong coordination and negotiation skills.