Internal Verificator
Core
Manage BPJS claim submissions, reimbursement tracking, and coding optimization for hospital operations.
Role type
Senior IC healthcare claims verifier
Builds
Accurate and compliant BPJS claim submissions and reimbursement processes
Domain
Healthcare administration + BPJS insurance operations
Deliverable
client delivery
Required skills
BPJS operations expertise, claim auditing, coding review, data analysis, regulatory compliance, fraud prevention, SOP development
Preferred skills
Digital verification implementation (VEDIKA), stakeholder collaboration
Technologies
BPJS VEDIKA system, hospital billing platforms
Responsibilities
Manage BPJS claim submission and reimbursement; Review coding input and hospital billing details; Monitor pending/disputed claims and develop SOPs; Collaborate with Finance and medical teams to resolve claim issues; Ensure compliance with BPJS regulations and prevent fraud; Support digital verification implementation.
Seniority
Mid-level, hands-on IC