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All Journal Community Engagement and Emergence Journal (CEEJ) Jurnal Ilmiah Multidisiplin Indonesia
Poltak Robert Budhialon
Sekolah Tinggi Manajemen Asuransi (STMA) Trisakti
Agriculture, Biological Sciences & Forestry Humanities Computer Science & IT Earth & Planetary Sciences Economics, Econometrics & Finance Education Engineering Environmental Science Health Professions Physics

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Pengenalan Profesi di Industri Perasuransian Bagi Siswa SMA Santo Fransiskus 2 Jakarta Reimond Hasangapan Mikkael Napitupulu; Usmawaty Rasyid; Poltak Robert Budhialon; R. Muh. Deddy Hanif Sardjito; Helmy Adam
Community Engagement and Emergence Journal (CEEJ) Vol. 5 No. 4 (2024): Community Engagement & Emergence Journal (CEEJ)
Publisher : Yayasan Riset dan Pengembangan Intelektual

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37385/ceej.v6i1.7133

Abstract

Kegiatan PkM yang dilaksanakan oleh para praktisi dan akademisi asuransi merupakan salah satu bentuk kegiatan dalam mendukung pemahaman siswa akan profesi dan karir didunia perasuransian. Tujuan dari kegiatan kolaborasi ini memperkenalkan profesi di dunia perasuransian, agar para siswa mengetahui pekerjaan pada dunia perasuransian. Pada kegiatan PkM ini yang dilaksanakan oleh praktisi dan Akademisi STMA Trisakti yang bertujuan untuk mengatasi segala risiko-risiko dalam industri perasuransian terutama dalam hal pemahaman profesi pada industri perasuransian di Indonesia.
Analysis of Loss Ratio and Determinants of High Health Insurance Claims in Employee Benefit Programs: A Case Study of PT XYZ for the 2024–2025 Period Senintyas Frestinawati; Poltak Robert Budhialon; Yulia Indah Permata Sari
Jurnal Ilmiah Multidisiplin Indonesia (JIM-ID) Vol. 5 No. 03 (2026): Jurnal Ilmiah Multidisplin Indonesia (JIM-ID), March 2026
Publisher : Sean Institute

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Abstract

The rising global healthcare costs have placed significant pressure on the sustainability of employer-sponsored health insurance programs. This study aims to analyze the loss ratio and identify the main determinants of high health insurance claims in the employee benefit program of PT XYZ for the 2024–2025 period. The research employed an analytical observational design using secondary claims data from 2024–2025. The analysis was conducted descriptively and inferentially by calculating the loss ratio, examining the frequency distribution of claims, determining the average cost per case, and performing comparative analysis based on type of service and membership status. The results show a loss ratio of 115.37%, indicating an underwriting deficit. Outpatient services dominated claim frequency (±78%), while inpatient services contributed the highest cost per episode. Dependent participants accounted for more than two-thirds of total claims. The primary determinants of increasing claims include the high frequency of outpatient visits, the high cost of inpatient care, and the utilization pattern among dependents. These findings highlight the importance of benefit design evaluation, utilization control strategies, and strengthening promotive and preventive programs to maintain the financial sustainability of the program.
Co-Authors Helmy Adam R. Muh Deddy Hanif Sardjito Reimond Hasangapan Mikkael Napitupulu Senintyas Frestinawati Usmawaty Rasyid Yulia Indah Permata Sari