Insurer Operations DX Planning and Development

This role belongs to the Insurer Support Business Division, which provides services for health insurance societies and mutual aid societies. The position will plan, develop, and operate an automated checking system that improves secondary claims review and re-examination requests for insurers.

Responsibilities include defining the product value and requirements for checking logic covering claims consistency, duplicates, reimbursement calculation rules, abnormal values, and other review items. The role will also design the operating model for the secondary claims review service and create an integrated workflow linking review results with data-health initiatives, such as recommendations to seek medical care and notifications through Pep Up.

The position will gather needs from insurers and the market, create a product roadmap, and plan functions intended to improve the convenience of existing review services. It will coordinate with sales, customer success, and development teams to optimize the process from implementation through operation.

Applicants must have at least three years of experience conducting claims review at a health insurance society or similar insurer, or at a claims-review company. Preferred experience includes practical involvement in implementing or operating claims software or an automated checking system; specialized knowledge of medical claims review items and the confirmation of questionable claims; understanding of health insurance treatment rules and the ability to respond appropriately to revisions of reimbursement schedules; and experience defining requirements for automated checks covering consistency, duplication, calculation rules, abnormal values, and high-cost claims. Experience collecting and analyzing data using Excel or similar PC tools is also requested.

The position is based at the Tokyo office in Minato, Tokyo, with remote work available. Employment is permanent and paid on a monthly salary basis; compensation is determined according to company rules and experience and ability. A three-month probationary period applies and may be extended by up to three additional months when deemed necessary. Overtime is paid separately. Working hours use a flextime system with core hours from 11:00 to 15:00, eight standard working hours per day, and a 60-minute break. The role includes social insurance, commuting allowance up to 150,000 yen per month, a defined-contribution pension plan, leave programs, employee stock ownership, and other stated employee support programs.