Our client, a global insurance company, is seeking an actuarial and pricing specialist to strengthen the pricing and claims management of its medical reimbursement insurance portfolio in Indonesia. The consultant will help address rising healthcare costs, claims volatility, and potential fraud or inappropriate claims, while developing robust analytical models and pricing recommendations to support long-term portfolio sustainability.

Key Responsibilities

• Actuarial modelling and analysis: Develop, refine, and apply models to analyse medical claims experience, claims trends, cost drivers, and portfolio performance.
• Medical reimbursement pricing: Review existing pricing assumptions and methodologies, recommend pricing adjustments, and assess their impact on profitability and product sustainability.
• Claims management: Analyse claims patterns and identify opportunities to improve claims monitoring, controls, and management practices.
• Fraud and leakage mitigation: Identify unusual claims trends, potential fraud indicators, and sources of avoidable claims costs, working with relevant internal teams to recommend mitigation measures.
• Portfolio sustainability: Assess the impact of medical inflation, utilisation trends, provider costs, and other relevant factors on future claims and pricing.
• Ongoing model refinement: Provide iterative technical input, update assumptions and models as new claims experience emerges, and recommend further pricing or claims interventions.
• Stakeholder collaboration: Work with actuarial, underwriting, product, claims, and other relevant teams to translate analytical findings into practical business recommendations.

Expected Deliverables

• Analysis of historical claims experience, key cost drivers, and emerging trends.
• Actuarial models and supporting analysis for claims forecasting and medical reimbursement pricing.
• Recommendations for pricing adjustments and sustainable portfolio management.
• Identification of claims management improvements and potential fraud or claims leakage mitigation opportunities.
• Ongoing model updates, technical guidance, and pricing recommendations throughout the engagement.

Ideal Profile

• Typically 10–20 years of relevant experience in actuarial analysis, health insurance pricing, medical reimbursement, or claims analytics.
• Strong experience in medical insurance pricing and actuarial modelling, preferably in markets with rising healthcare costs and complex claims dynamics.
• Proven ability to analyse claims data, identify cost drivers, develop pricing recommendations, and assess portfolio profitability.
• Experience in claims management, fraud analytics, claims leakage, or healthcare cost containment is highly desirable.
• Regional experience across Southeast Asia or other comparable markets is preferred.
• Qualified actuary preferred, but not mandatory if the candidate has strong technical modelling, pricing, and relevant health insurance experience.
• Comfortable providing both hands-on technical analysis and ongoing advisory support to business stakeholders.