Azmi Tanjung
Senior Claims Analyst. Expert In Health Insurance, Cost Containment & Claim Review
Bandung
Summary
Registered Nurse with over a decade of expertise in health insurance, specializing in medical claims analysis, cost containment, and clinical review. Proven ability to meticulously evaluate inpatient and outpatient claims, ensuring policy compliance while identifying discrepancies. Skilled in collaborating with healthcare providers and internal stakeholders to optimize claim outcomes, leveraging strong analytical skills and clinical knowledge for precise and efficient decision-making. Eager to contribute to a global insurance organization in a senior claims or medical advisor role, driving impactful solutions and enhancing organizational success.
Overview
11
11
years of professional experience
2
2
Languages
Work History
PMN Health and underwriting
Prudential Indonesia (PT Prudential Life Assurance)
03.2020 - Current
- Reviewed and analyzed medical claims (inpatient & outpatient).
- Ensured compliance with policy terms, reducing claim leakage.
- Identified fraudulent or excessive claims through medical review.
- Collaborated with hospitals and providers to validate treatment and billing.
- Supported cashless claim operations and case escalations.
- Contributed to process improvements in claim adjudication.
- New Joiner Trainer.
- Involved in building the cashless project at Prudential.
PRUHospital Friend
Prudential Indonesia (PT Prudential Life Assurance)
08.2018 - 03.2020
- Managed cashless claim administration for inpatient, outpatient, and One DaySurgery (ODS) cases.
- Reviewed medical supporting documents, length of stay, and hospital billingtoensure claim accuracy.
- Processed reimbursements for pre-admission, outpatient services,andcoverage differences.
- Provided clear policy information to customers and efficiently handled complaints and inquiries.
- Supported the Head Office Claim Pending Team in resolvingoutstandingcases.
Hospital Helpdesk
PT Asuransi Jiwa Sequis Life
04.2015 - 08.2018
- Served as Hospital Helpdesk, a dedicated representative stationed at SequisLife partner hospitals.
- Facilitated and supported customers with their cashless hospitalization claims, ensuring accuracy and efficiency.
- Acted as the central liaison between the hospital, customers, and the third-party administrator to deliver a smooth and seamless claims process.
Education
S.Kep NERS - Registered Nurse
STIKep PPNI JABAR
Bandung09-2014
Skills
Claims analysis
Claims investigation
Policy interpretation
Teamwork
Microsoft office
Problem-solving
Data entry
Timeline
PMN Health and underwriting
Prudential Indonesia (PT Prudential Life Assurance)
03.2020 - Current
PRUHospital Friend
Prudential Indonesia (PT Prudential Life Assurance)
08.2018 - 03.2020
Hospital Helpdesk
PT Asuransi Jiwa Sequis Life
04.2015 - 08.2018
S.Kep NERS - Registered Nurse
STIKep PPNI JABAR