Pengalaman Petugas Administrasi Dalam Melakukan Penginputan Data Klaim ke Badan Penyelenggara Jaminan Sosial (BPJS) di Rumah Sakit

Titi Restui (Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum PSDKU Kab Temanggung)
Suci Artanti (Sekolah Tinggi Ilmu Kesehatan Bethesda Yakkum PSDKU Kab Temanggung)
Berlian Nurtyashesti Kusumadewi (STIKES Ngesti Waluyo)

Jurnal Kesehatan
Vol 15 No 1 (2026): JURNAL KESEHATAN

Entering claim data for social security agency on health is an important process in the hospital administrative system, requiring accuracy and efficiency to prevent delays and claim rejections. This study aimed to explore the experiences of administrative staff in entering social security agency on health claim data at Harapan Hospital. The study employed in-depth interviews with five participants from the administrative services management unit. The analysis identified several themes: (1) challenges faced by administrative staff when entering claim data documents for social security agency on health; (2) acquisition of knowledge and skills regarding entering claim data procedures; (3) availability of standard operating procedures entering claim data processing for social security agency on health; (4) the role of information technology in supporting administrative staff in social security agency on health claim data entry; (5) evaluation and recommendations for improving software and network systems used in the social security agency on health process; and (6) expectations for improving knowledge and skills entering claim data procedures for social security agency on health. The findings showed that the data entry process still faced various challenges. In terms of human resources, there was a mismatch between the tasks performed by administrative staff and their assigned job descriptions, as well as disparities in staff competencies. The standard operating procedures had not been properly disseminated and were not accessible to all staff. From a technological perspective, the claims software had not functioned optimally due to frequent maintenance issues and slow internet connectivity. In addition, the absence of integration (bridging) between the hospital management information system for outpatient services and Indonesia Case Base Groups (INA CBG’s) application required staff to enter data manually, thereby increasing the risk of errors and delays. These findings highlight the need to improve human resource capacity, reorganize and strengthen standard operating procedures implementation, and enhance information system infrastructure to support a more effective and accurate claims process.