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STRATEGI POTENSI IMPLEMENTASI ALUR KLAIM JAMSOSTEK UNTUK MENINGKATKAN EFISIENSI PROSES KLAIM BPJS KESEHATAN DALAM MENGATASI HAMBATAN PROSEDURAL

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Procedural barriers in the BPJS Kesehatan claim process such as document verification complexity, lack of integration in information systems, high rates of pending claims, and delayed payments, remain critical issues that affect the performance of healthcare facilities. This study aims to formulate an implementation strategy for adapting the Jamsostek claim workflow into the BPJS Kesehatan claim system to enhance claim process efficiency. The research employs a descriptive qualitative approach, collecting data through in-depth interviews with informants from BPJS Kesehatan, BPJS Ketenagakerjaan, and partner hospitals, as well as through official document reviews and observations. Data validation was conducted using methodological triangulation, source triangulation, and data triangulation to ensure the credibility of the findings. The analysis reveals that early-stage digital verification, the application of Service Level Agreements (SLA) at each claim stage, automated inter-stakeholder notification systems, and real-time dashboard-based monitoring can accelerate verification processes, reduce repetitive document revisions, minimize pending claims, and improve payment certainty. The novelty of this study lies in the formulation of an operational adaptation strategy of the Jamsostek claim workflow as an applicable implementation model for BPJS Kesehatan, extending beyond mere system comparison. These findings provide a scientific basis for strengthening BPJS Kesehatan’s claim governance through digital integration, enhanced coordination, and improved verification effectiveness.

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Detail Information

Series Title

-

Call Number

T1937452026

Publisher

Indralaya : Prodi Kesehatan Masyarakat, Fakultas Kesehatan Masyarakat Universitas Sriwijaya., 2026

Collation

xviii, 47 hlm.; ilus.; tab.; 29 cm

Language

Indonesia

ISBN/ISSN

-

Classification

362.106 807

Content Type

Text

Media Type

unmediated

Carrier Type

other (computer)

Edition

-

Subject(s)

Manajemen Layanan Kesehatan
Prodi Kesehatan Masyarakat

Specific Detail Info

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Statement of Responsibility

SEW

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