Casemix Claims Verifier & Lead – BPJS Compliance

Siloam Hospitals Group; Tangerang; On-site; IDR 100,440,000 - 145,080,000; Full time

Benefits offered by this job

BPJS health program support

Job summary

Siloam Hospitals Group is seeking an Internal Verificator in the Casemix Department for a full-time role. You will manage BPJS claim submissions and reimbursements, and lead Coders (OPD and IPD) while ensuring complete and timely submissions.

You will verify document completeness, coordinate with Specialists, Front Office and Coders, and review coding inputs to ensure accuracy in hospital billing and adherence to INA-CBG guidelines.

Qualifications

• Bachelor Degree in Healthcare Administration, Health Information Management, Accounting, or related major.
• Active Medical Registration Certificate (STR).
• Minimum 2 years of BPJS operations or Casemix experience.
• Knowledge of BPJS Kesehatan claim processes and hospital workflows.

Responsibilities

• Manage submission and reimbursement of BPJS claims and lead Coders (OPD/IPD).
• Review coding input and hospital billing details for accuracy.
• Check completeness of documents required to submit a claim.
• Communicate with Specialists, Front Office and Coders for changes in claim documentation.
• Monitor pending/disputed/inappropriate claims and coordinate with Finance and BPJS to resolve issues.
• Collaborate with Casemix Manager, Specialist, RMO and BPJS on processes and SOPs.

Skills

Analytical skills

Attention to detail

Internal controls

Data auditing

Communication

Education

Healthcare Administration / Health Information Management / Accounting (any related major)

Bachelor of Medicine and Medical Profession (S1 Profesi Dokter)

Job description

Siloam Hospitals Group is seeking an Internal Verificator in the Casemix Department for a full-time role. You will manage BPJS claim submissions and reimbursements, and lead Coders (OPD and IPD) while ensuring complete and timely submissions.

You will verify document completeness, coordinate with Specialists, Front Office and Coders, and review coding inputs to ensure accuracy in hospital billing and adherence to INA-CBG guidelines.