Yeyen Usman

Medical Doctor with more than 10 years of experience in health insurance and provider management. Proven track record in leading claims operations, optimizing healthcare cost, strengthening provider partnerships, driving digital initiatives, and delivering excellent service quality. Strong leadership in managing cross-functional teams, fraud investigation, medical advisory, and strategic healthcare projects.

Head of Claim Health – Subordinate 8 (Individual & Corporate) - ASURANSI TAKAFUL KELUARGA

(2025-01)

• Lead end-to-end health claim operations (cashless & reimbursement) in compliance with SOP and SLA.
• Oversee and ensure smooth guarantee processes for preadmission, admission, discharge, and case monitoring (Inpatient & outpatient).
• Perform in-depth analysis and reporting including RBNA and claims performance.
• Provide medical advisory support to internal claims and external clients.
• Build and maintain strategic partnerships with hospitals, TPA, and vendors (AI, OOC, outsourcing) including negotiation, evaluation and performance review.
• Collaborate with Sales, Pricing, IT, Finance, and other departments to ensure smooth implementation of business processes.
• Ensure accuracy and completeness of claims documentation and data, including system uploads via API integration.
• Monitor the utilization of funds for claim payments for ASO policies and TPA as payor policies.
• Conduct fraud detection and investigation for reimbursement claims and mitigate potential risks.

Manager Provider Relation – Subordinate 2 - AIA FINANCIAL

(2024-01 - 2025-12)

• Manage and establish strategic collaboration with hospitals including negotiation, evaluation and performance review.
• Coordinate with Case Management, Pricing, IT, Finance and other departments to ensure smooth business process implementation.

Head of Pre-Operate Clinic – Subordinate 4 - EKA HOSPITAL BSD

(2023-01 - 2024-12)

• Increase PBD conversion and ensure successful execution of scheduled surgical procedures.
• Provide special pricing and discounts for patients.
• Review LMA & LML to ensure compliance with insurance policy provisions.
• Handle and resolve patient complaints effectively.

Assistant Manager Minor Claim – Subordinate 8 (Individual) - PRUDENTIAL LIFE ASSURANCE

(2022-01 - 2023-12)

• Lead reimbursement claim processing in accordance with SOP and SLA.
• Provide medical advisory and conduct analysis on reimbursement claims.
• Conduct NPS & CSAT analysis to monitor service quality and customer satisfaction.

Section Head of Claim Health – Subordinate 21 (Corporate) - ASURANSI ASTRA

(2015-01 - 2022-12)

• Manage health claim operations (cashless & reimbursement) in accordance with SOP and SLA.
• Provide medical advisory and conduct case monitoring, clinical meetings, and hospital visits.
• Lead fraud detection and investigation for reimbursement claims.
• Collaborate with Marketing, Pricing, IT, Provider Relation, CIO and other departments.
• Handle and resolve complaints from members, SP, HR and PIC.

Medical Doctor - Diponegoro University, Semarang (1999-01 - 2005-12)

Bachelor of Medicine - Diponegoro University, Semarang (1999-01 - 2003-12)