This assignment supports administration and claims verification for Bogor City's regional health insurance programme (Jamkesda).
The scope includes service guarantee documentation, administrative and medical verification of hospital claims for January–December 2015, verification records, and regular utilization and expenditure reports. It also covers high-risk and high-cost case management and maintenance of claims data.
Description of Assignment:
- Management of administrative verification and reporting in the issuance of Service Guarantee Letters (SJP) for Jamkesda participants in Bogor City.
- Management of medical verification and reporting of advanced health care claims from hospitals (claims January to December 2015)
- Publication of Minutes and recapitulation of claim verification results from each hospital.
- Utilization report (UR) and financing of health services in hospitals for Jamkesda participants (monthly, quarterly, semi-annually and annually) the Bogor City Health Office.
- Case management for high-risk and high-cost cases;
- Claims data management and documentation.
