Internal Verificator
Core
Manage BPJS Kesehatan and insurance claim submissions, supervise medical coding teams, and ensure compliance with regulations to optimize claim accuracy and minimize fraud risk.
Role type
Medical Verifier / Claims Specialist
Builds
Accurate medical claims and compliant coding for BPJS Kesehatan and insurance providers
Domain
Healthcare administration / Insurance claims
Deliverable
client delivery
Required skills
Medical coding, BPJS Kesehatan regulations, insurance claim processes, medical documentation review, fraud risk mitigation, team supervision
Preferred skills
Casemix management, hospital workflow knowledge, digital verification tools (VEDIKA)
Responsibilities
Manage submission and reimbursement processes for BPJS Kesehatan and insurance claims; Lead and supervise the OPD and IPD Coding Team; Review completeness of medical and administrative documents; Coordinate with Specialists, RMO, Front Office, Coders, and Casemix Manager; Monitor status of pending, disputed, and rejected claims; Analyze causes of claim issues and provide optimization recommendations; Ensure compliance with INA-CBG and insurance requirements.
Seniority
Entry-level to Junior (fresh graduates welcome)