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All Journal LOGIK@ Jesya (Jurnal Ekonomi dan Ekonomi Syariah) JURNAL MANAJEMEN BISNIS Dinasti International Journal of Economics, Finance & Accounting (DIJEFA) Jurnal Ekonomi Bisnis, Manajemen dan Akuntansi (JEBMA) An-natiq: Jurnal Kajian Islam Interdisipliner Jurnal Perempuan & Anak Jurnal Ilmiah Spiritualis: Jurnal Pemikiran Islam dan Tasawuf INTERNATIONAL JOURNAL OF CULTURAL AND SOCIAL SCIENCE NUSANTARA: Jurnal Pengabdian Kepada Masyarakat Jurnal Penelitian Ilmu Ekonomi dan Keuangan Syariah Jurnal Pengabdian Masyarakat dan Riset Pendidikan At- Ta'lim : Jurnal Pendidikan Ngaliman ILJS Jurnal Publikasi Manajemen Informatika
Budi Harianto
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Religion Humanities Computer Science & IT Decision Sciences, Operations Research & Management Economics, Econometrics & Finance Education Environmental Science Languange, Linguistic, Communication & Media Law, Crime, Criminology & Criminal Justice Library & Information Science Mathematics Social Sciences Other

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Analisis Strategi Manajemen Klaim dalam Menekan Resiko Fraud di PT. Asuransi Panin Dai-Ichi Life Elyana Syakira; Aqwa Naser Daulay; Budi Harianto
Jurnal Penelitian Ilmu Ekonomi dan Keuangan Syariah Vol. 4 No. 2 (2026): Mei : Jurnal Penelitian Ilmu Ekonomi dan Keuangan Syariah
Publisher : STAI YPIQ BAUBAU, SULAWESI TENGGARA

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59059/jupiekes.v4i2.3372

Abstract

Insurance fraud is a latent threat that can disrupt the financial stability of life insurance companies. PT Panin Dai-Ichi Life Medan Branch faces significant challenges in safeguarding against illegitimate claims driven by criminal intent. This study aims to analyze the effectiveness of claim management strategies in mitigating fraud risks in Medan. This study employs a qualitative descriptive case study method. Data gathered through in-depth interviews and documentation were analyzed using a SWOT matrix (IFAS/EFAS) based on Fraud Risk Assessment. The analysis revealed a net IFAS score of +0.48 and an EFAS score of +0.71, positioning the company in Quadrant I (Aggressive Strategy). The primary strength lies in the multi-layered clinical verification by the internal Casemix medical team and strict adherence to prompt payment SOPs. However, challenges persist regarding digital document manipulation and dispute risks due to agent mis-selling. The S-O (Strengths-Opportunities) Strategy is highly recommended, focusing on integrating the claim system with partner hospitals' e-medical records, utilizing AI for anomaly detection, and reinforcing anti-fraud compliance under OJK regulations and Law No. 4 of 2023 on PPSK.
Co-Authors Ahmad Syakir Anisah Cyntia Dewi Pratama Aqwa Naser Daulay Aqwa Naser Daulay Bobby Rachman Santoso Elyana Syakira Feby Nurhalizah Siregar Heru Arif Pianto, Heru Arif Husni Mubarak Iik Ariyanti Indah Khuzaimah Jahara Siregar Kusmilawaty Kusmilawaty Lathifah Ananda Putri M. Yusuf Muhajir, As'aril Muhammad Yuda Hendrawan Nadya Asanul Husna Nur Inayah Nurul Jannah Nurul Syalafiyah Rini Andriansi Rizka Afriani Sarah Harefah Saputri Sari Harahap, Siska Permata Syalafiyah, Nurul Vany Fadilah Bastian Zainarti