ANALYSIS OF HUMAN RESOURCES ROLE IN CASEMIX UNIT IN MANAGING CLAIMS OF SOCIAL SECURITY AGENCY (BPJS) AT HOSPITAL X

Abstract

The Indonesian government has created a health service program as an effort to improve health in Indonesia through the Social Security Agency (BPJS). BPJS claim management in hospitals is highly dependent on the role of the casemix unit, but the role of Human Resources (HR) in the casemix unit is considered as a very important factor in ensuring the accuracy of files, completeness of files, and timeliness of delivery and submission of claims. Referring to the ongoing obstacles in implementing the role of HR, this study aims to determine the role, number, and obstacles faced by HR in the casemix unit. This study used a descriptive qualitative method with data from the casemix unit, filling out questionnaires, and in-depth interviews with seven HR in the casemix work unit of X Hospital which were conducted from April 2025 to May 2025. The results show that HR in the casemix unit has tried to conduct its role optimally, even though it is faced with a high frequency of overtime due to a workload which exceeds 8 hours per day and the number of HR that is still insufficient. There are several obstacles which come from outside the casemix unit; especially, in the delay of filing, system errors, changing BPJS regulations, and obstacles in the number of insufficient human resources so that the frequency of overtime is quite high and requires additional freelance workers. This finding shows the need for better coordination between the casemix unit and other units which are directly related to BPJS services, the need for HR training, and the need to increase the number of HR in order to increase the effectiveness of BPJS claim management at X Hospital.