Casemix Claims Verifier & Process Optimizer

Siloam Hospitals Group (Tbk); Tangerang; On-site; IDR 111,600,000 - 223,200,000; Full time

Job summary

Siloam Hospitals Group is seeking an Internal Verificator in the Casemix Department to oversee BPJS claim submissions, coding accuracy, and document completeness. You will coordinate with medical and administrative teams to resolve issues and enhance claim processing efficiency.

The role requires a healthcare-related bachelor degree, an active STR, and at least one year of Casemix/BPJS experience. Strong analytical skills and attention to detail are essential.

Qualifications

• Bachelor Degree in Healthcare Administration, Health Information Management, Accounting or related major.
• Active Medical Registration Certificate (STR).
• Minimum 1 year experience in Casemix, BPJS Kesehatan or insurance is a plus.
• Knowledge of hospital workflows, medical documentation, coding and BPJS processes.

Responsibilities

• Manage submission and reimbursement of BPJS claims and lead Coders; review work for accuracy and timeliness.
• Check completeness of documents required to submit a claim.
• Communicate with Specialists, Front Office and Coders for changes to claim documentation.
• Review coding input and hospital billing details in INA-CBG as carried out by Coder.
• Ensure claims comply with patient care class and BPJS regulations.

Skills

Analytical skills

Attention to detail

Internal controls

Education

Bachelor in Healthcare Administration

Bachelor in Health Information Management

Bachelor in Accounting

Bachelor of Medicine / Medical Profession (S1 Profesi Dokter)

Job description

Siloam Hospitals Group is seeking an Internal Verificator in the Casemix Department to oversee BPJS claim submissions, coding accuracy, and document completeness. You will coordinate with medical and administrative teams to resolve issues and enhance claim processing efficiency.

The role requires a healthcare-related bachelor degree, an active STR, and at least one year of Casemix/BPJS experience. Strong analytical skills and attention to detail are essential.