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Azmi Tanjung

@azmitanjung

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Registered nurse and claim analyst improving clinical review accuracy and fraud detection.

Indonesia

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What I'm looking for

I’m looking for a role in medical claims where I can apply clinical review, analytics, and fraud detection to improve accuracy, speed, and customer experience—while working closely with providers and continuously refining processes.

I’m a Registered Nurse turned Claim Analyst with 10+ years in the health insurance industry. I combine clinical knowledge with strong analytical skills to support accurate decision-making and service excellence across medical claim operations.

In my roles, I reviewed both inpatient and outpatient claims, including domestic and overseas cases. I’m focused on validating medical procedures and hospital billing, analyzing length of stay, and strengthening medical necessity review to ensure claims align with policy provisions.

I’ve built impact through fraud and quality work—identifying indications of fraud, abuse, and excessive claims, and handling escalation cases when accuracy and compliance matter most. I also contributed to claim adjudication process improvements to enhance efficiency, accuracy, and service speed, while collaborating closely with healthcare providers and hospitals.

Beyond core claims work, I’ve supported and modernized operations through analytics and automation. I audited and reconciled claim data using Life Asia System and CMS with Power BI and Excel, helped train new joiners on claim workflows, and contributed to PRUMedical Network (PMN) and automation systems like OCR and BRMS—then later shifted into education and AI content quality review.

Experience

Work history, roles, and key accomplishments

Current

Insurance & Healthcare Education Trainer

Current

Indonesia Healthcare RemoteHub (IHRH)

Apr 2026 - Present (3 months)

Develop and deliver health insurance and medical claims education for healthcare professionals. Create training materials and learning programs covering fraud awareness, medical necessity review, and healthcare operations.

Health Insurance Training Medical Necessity Review Webinar Content Development Training Materials Health Education Claims Analysis Fraud Awareness Training Educational Ebooks Healthcare Operations

Current

AI Content Reviewer

Current

RWS Group

Apr 2026 - Present (3 months)

Review AI-generated multilingual content for quality, accuracy, consistency, and adherence to instructions and guidelines. Support AI training workflows using validated content and response assessment on text and multimodal datasets.

AI Content Review Quality Assurance Content Validation Multilingual Evaluation Evaluating Responses Compliance Review Accuracy and consistency checking

Senior Claim Analyst - PMN

Prudential Life Assurance

Mar 2020 - Apr 2026 (6 years 1 month)

Reviewed and analyzed inpatient and outpatient medical claims for accuracy and compliance, including fraud and abuse indicators. Audited and reconciled claim data using Power BI and Excel, supported cashless claim operations, and contributed to PRUMedical Network (PMN) and automation onboarding (OCR/BRMS).

Medical Review Fraud Detection Claim Adjudication Cashless Claims Provider Relations Power BI Excel Life Asia Data Reconciliation BRMS Automation Data Auditing

Senior Claim Analyst

Prudential Life Assurance

Mar 2020 - Apr 2026 (6 years 1 month)

Reviewed and analyzed inpatient and outpatient medical claims for accuracy and compliance with insurance policy provisions, including fraud and excessive-claim indicators. Audited and reconciled claim data across Life Asia System and CMS using Power BI and Excel, and supported cashless claim operations and escalation cases.

Medical Review Fraud Detection Cashless Claims Claim Adjudication Provider Relations Power BI Excel Life Asia CMS Process Improvement

PRUHospital Friend

Prudential Life Assurance

Aug 2018 - Mar 2020 (1 year 7 months)

Managed end-to-end cashless and reimbursement claim administration for inpatient, outpatient, and One Day Surgery cases. Performed medical review and cost/length-of-stay evaluation, handled escalations as a primary liaison for customers and agents, and supported complex claim inquiries.

Cashless Claims Medical Review Cost Analysis SLA Management Escalation Handling Cashless Claims Administration Same Day Surgery Stakeholder Management Customer Service

Hospital Helpdesk

Sequis Life

Apr 2015 - Aug 2018 (3 years 4 months)

Handled cashless claim processes for inpatient, outpatient, and One Day Surgery cases and processed reimbursement claims in line with SLA standards. Reviewed medical documents and hospital billing, assessed length of stay, communicated policy information, and coordinated resolution of pending/complex cases with Head Office.

Cashless Claims SLA Management Complaint Handling Case Coordination Data Entry