| Title | ANALISIS PROSES PELAKSANAAN INVESTIGASI FRAUD DALAM PRODUK HOSPITAL CASH PLAN DI PT COMMONWEALTH LIFE |
|---|---|
| Author | Hendrik Herdiana Sutendi |
| Abstract | Fraud has been serious problem in henlth insuramce, this is because it can lead to higher in health insurance premiumms and prolong the claints process. Technological changes und the loopholes in the hospital cash plan insurance products led to the mcreasingly in fratud TEImber und Organized crinie has started to lsecome involved Hospital Cashplan fraud claiins has grown uver the years. Claim anvestigationn has an important role in eracking this fraud. For this reason, an eflective inveytigation model is needed and so that it can reveal fraudulent actions against clainis und conduct early detection as a preventive nieastre in the future, The resenrcher used a desculptive yualitative approach. where researchers conducted gliservalions of the hospital eash jplarn fraid process at PT Commonwealth Life from 2014 2018 and conducted in-depth interviews with several parties relating to the claims process lind its resolution. The current model of claim investigation has been earried out effectively but it is necessary to coordinate with related departments so that in the future this mitigation of fraud ean be comprehensively prevented. Keyword : fraud, hospital cash plan, claim, underwriting |
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