CV NARSUM TRAINING MIKA

CV SINGKAT PENGAJAR

1 PRINSIP DAN PRODUK ASURANSI KESEHATAN

Dr. Rosa Christiana Ginting, Betr,med, MHP, HIA, AAK, CHIP Tempat/tgl lahir : Kabanjahe 25 Desember 1953 Pendidikan :  1990 : Medical Faculty, North Sumatera University, Medan : Graduated Medilcal Doctor  1990 : Occupational Medicine, Friederich Wilhelm University, Bonn, Jerman  1995 : Health Insurance, UCLA, USA  1998 : Health Insuraence Associate and Manage Health Profesional, (HIAA)  2017 : Certified on Health Insurance Peofessional (CHIP) by National Certification Board on Professionalism Pengalaman Kerja : : Independent Commissioner of International Siloam Hospital Group  2020 - Sekarang : Supervisiory Board of St Carolus Hospital  2018 - Sekarang : President & Independent Commissioner of Cigna Indonesia  2015 - Sekarang : Independence Commissioner of Cigna Indonesia  2013 – 2015 Pengalaman Organisasi :  2018 – Sekarang : Chairman – Association of Professional on Health Insurance  2016 – Sekarang : Indonesian Chamber of Commerce : National Health Insurance Committee  2014 – 2018 : Advisory – Association of Professional on Health Insurance  2010 – 2014 : Chairman - Association of Professional on Health Insurance  2010 – 2013 : Advisory- Association of Life Insurance Indonesia  Association Of Indonesian Family Physician

2 PENGENALAN PRODUK ASURANSI KESEHATAN II

Pendidikan : dr. Nanny Nusalim, MHP, ANZIIF, FLMI, AIAA, • 1986 : Fakultas Kedokteran, Universitas Sumatera Utara ACS, AAK,CHIA • 1994 : New Zealand Insurance Institute • 1999 : FLMI dari LOMA • 2001 : MHP dari Health Insurance Association of America Pengalaman Kerja : • 2018 - Sekarang : Komisaris Utama, Cipta Integra Duta • 2002 – 2018 : Direktur Utama, Cipta Integra Duta • 2017 – Sekarang : Komisaris, Cipta Hidup Sejahtera • Medical advisory council, Prudential Assurance • Konsultan, Asuransi Jiwa BCA Life • 1996 – 2002 : Direktur, ING Insurance • 1988 – 1996 : Operasional asuransi kesehatan, ING Insurance Pengalaman Organisasi : • 2000 – 2008 : Chairman LOMA Society • 2015 – 2019 : Ketua LDP Pamjaki • 2018 – 2021 : Pengurus IDI Bidang Kajian dan Pengembangan Model Pembiayaan Pelayanan • 2018 : Anggota Tim Gugus Tugas Wisata Kesehatan Kementerian Kesehatan • 2021 : Wakil Ketua Lembaga Diklat Pamjaki

3 ADMINISTRASI KLAIM DI RUMAH SAKIT (CLAIM MANAJEMEN)

Profile : Dr. Emira E Oepangat FLMI, ACS, UND, CFP, QCRO, AEPP, QFE, AAAIJ, • Medical Doctor AAAK • Life And Health Underwriter And Claims • Life And Health Insurance Operations • Internal Auditor (ISO STANDARISATION) • Project Manager • Financial Planner • Health And Wellness Advocate Education And Designations : • Universitas Airlangga – Medical Faculty • LOMA Designations: FLMI, ACS, UND • Financial Planners Designations: CFP, AEPP, QFE • Indonesian Insurance Qualifications : For Health Insurance (AAAK); For Life Insurance (AAAIJ) Professional Activities : Seorang Dokter yang jatuh • PRESIDENT, LOMA SOCIETY OF INDONESIA cinta dengan dunia asuransi dan • Facilitator And Trainer, LPAI – STIMRA For Life And Health Insurance • Meber of The Advisor Board, Financial Planner Board Standard – Indonesia menggeluti dunia • Committee Member of PAMJAKI – Indonesian Association of Health Insurance and Managed Care • Advisor, Yayasan Orang Tua Peduli – NGO That Actively Involve in Rationalisastion Use of Drugs and Antibiotics Asuransi Kesehatan dan Asuransi Skills And Experience : Jiwa • Bilingual (Indonesian – English) • Life and Health Operations • Underwriting anf Claims Management • Project Management Built Syariah Business Unit • Marketing – Communications and Brand Management • Employee Benefits Management Corporate Sales

4 MANAJEMEN KLAIM RUMAH SAKIT

dr. Ricky Jansen Waworuntu, MM, AAAK Tempat/tgl lahir : Makassar, 24 Januari 1962 Pendidikan : • Dokter Umum, Fakultas Kedokteran Universitas Sam Ratulangi, Manado, 1986 • S2 - Magister Management Universitas Airlangga, Surabaya, 1996 • Sertifikasi PAMJAKI, Ajun Ahli Asuransi Kesehatan, 2009 • Sertifikasi IKKESINDO, Konsultan Manajemen Kesehatan, 2021 Pengalaman Kerja : : Dosen Fakultas Kedokteran Univ. Sam Ratulangi (PNS) : PT. Wenang Sakti (Duta Dharma Bakti Group), Sulawesi Utara • 1987 – 1989 : PT Askes Persero • 1989 – 1997 : PT Asuransi Jiwa InHealth Indonesia • 1998 – 2009 • 2009 – 2021 Pengalaman Organisasi : • Ketua DPD APINDO (Asosiasi Pengusaha Indonesia) Provinsi Sulawesi Utara, 1990-1995 • Ketua DPD APHI (Asosiasi Pengusaha Hutan Indonesia) Provinsi Sulawesi Utara, 1989 - 1994 • Pengurus Harian DPD REI (Real Estate Indonesia) Provinsi Sulawesi Utara 1991 - 1994 • Pengurus Harian DPD KADIN (Kamar Dagang dan Industri Indonesia) Provinsi Sulawesi Utara 1990 - 1994 • Wakil Bendahara DPD GOLKAR (Golongan Karya) Kota Manado 1993 - 1998 • Wakil Ketua PD FKPPI (Forum Komunikasi Putra Putri Purnawirawan ABRI) Kota Manado, 1992 - 1996

5 DISPUTE KLAIM ANTARA ASURANSI DENGAN RUMAH SAKIT

Dr. Sumiarsih Pujilaksani, MKM, AAK, CHIA Pendidikan : • 1988 – 1994 : Fakultas Kedokteran Umum, Universitas Indonesia (S1) • 2005 – 2007 : FKM Universitas Indonesia, Asuransi Kesehatan (S2) Pengalaman Kerja : • 2011 – Sekarang : PT. Solusi Profesional Medika Indonesia, Healthcare Consulting Direktur • 2015 – 2017, : PT. Asuransi Umum Mega, Kepala Divisi Operasional Health 2019 – 2020 (Polis & Kepesertaan, Jaminan, Claim & Provider) • 2010 – 2011 : PT. AXA Financial Indonesia, Claim Manager (Individu & Corporate) • 2004 – 2010 : BAPEL JPK Mitra Kesehatan Jaya, Kepala Divisi Pelayanan Kesehatan Jaminan dan Casemangmen, Claim & Provider • 2001 – 2004 : PT. Allianz Life Indonesia, Assmen Preauthorization & Case Management • 1998 – 2001 : PT. JPK Citra Huada Gobel, Medical Auditor & Coordinator 5 Clinic • 1998 – 2001 : Psukesmas Korpri Bandar Lampung, Dokter PPT