Claim Handler

Company Description Sembuh AI is a trusted partner for the global health insurance ecosystem, powering modern insurers, TPAs, reinsurers, and brokers with smarter claims intelligence. Our technology uses Artificial Intelligence that integrates with existing systems to automate claims processing, enhance fraud detection, and improve portfolio visibility. We empower insurance providers with smarter, faster, and fairer claims handling, driving real impact across the insurance industry.

Responsibilities

• Receive, log, and categorise all incoming claims (inpatient cashless, reimbursement, outpatient) into the Sembuh AI system; ensure correct initial data entry
• Verify administrative compliance against policy terms (benefit limits, waiting periods, exclusions, coverage scope); review AI-flagged claims for non-clinical discrepancies without making clinical determinations