Proses penyelesaian klaim asuransi non-JKN di rumah sakit memiliki peran penting dalam menjaga kelancaran arus kas dan keberlangsungan operasional. Keterlambatan dalam proses klaim dapat berdampak pada waktu penerimaan pembayaran. Penelitian ini bertujuan untuk menganalisis ketepatan waktu dan proses penyelesaian klaim asuransi non-JKN di RS UI tahun 2025. Faktor input yang diteliti meliputi SDM, sarana dan prasarana, kelengkapan berkas klaim, dan jenis asuransi. Penelitian ini juga menganalisis distribusi waktu pada setiap tahapan proses, meliputi T1 (discharge to closed), T2 (closed to invoicing), T3 (invoicing to sending), dan T4 (sending to payment), serta hambatan yang terjadi hingga tahap pembayaran klaim. Penelitian ini menggunakan desain potong lintang dengan pendekatan kuantitatif dan kualitatif. Data kuantitatif diperoleh dari seluruh klaim asuransi non-JKN tahun 2025 sebanyak 7313 klaim, sedangkan data kualitatif diperoleh melalui wawancara mendalam dengan informan yang terlibat dalam proses klaim di unit AR. Hasil penelitian menunjukkan bahwa sebagian besar klaim telah diselesaikan sesuai dengan target ≤55 hari dengan persentase 83,5% dan rata-rata total waktu penyelesaian sebesar 29 hari. T4 merupakan tahapan dengan durasi paling lama dan menjadi bottleneck dalam proses klaim. Faktor input secara umum telah mendukung proses, tetapi masih ditemukan kendala terkait ketidaklengkapan berkas klaim, keterbatasan SDM pada kondisi tertentu, dan sistem yang belum optimal. Terdapat variasi waktu penyelesaian klaim berdasarkan jenis perawatan dan jenis asuransi yang dipengaruhi oleh kompleksitas berkas dan perbedaan kebijakan asuransi. Hambatan dalam proses klaim didominasi oleh faktor internal rumah sakit, meskipun faktor eksternal juga turut memengaruhi. Secara keseluruhan, proses penyelesaian klaim asuransi non-JKN di RS UI telah berjalan cukup baik, tetapi masih diperlukan perbaikan pada kelengkapan berkas klaim, optimalisasi sistem, dan pengelolaan SDM untuk meningkatkan efisiensi dan konsistensi dalam pencapaian target waktu penyelesaian klaim.

The process of non-JKN insurance claim settlement in hospitals plays an important role in maintaining cash flow and ensuring operational sustainability. Delays in the claim process still occur and may affect the timeliness of payment receipt. This study aims to analyze the timeliness and process of non-JKN insurance claim settlement at Universitas Indonesia Hospital in 2025. The input factors examined included human resources, facilities and infrastructure, completeness of claim documents, and type of insurance. This study also analyzed the time distribution at each stage of the claim process, including T1 (discharge to closed), T2 (closed to invoicing), T3 (invoicing to sending), and T4 (sending to payment), as well as the barriers encountered until the payment stage This study employed a cross-sectional design using quantitative and qualitative approaches. Quantitative data were obtained from a total of 7,313 non-JKN insurance claims in 2025, while qualitative data were collected through in-depth interviews with informants involved in the claim process within the AR Unit. The results showed that the majority of claims were completed within the target of  ≤55 days, accounting for 83,5% of all claims, with an averge total processing time of 29 days. T4 was identified as the longest stage and became the bottleneck in the claim process. In general, the input factors supported the claim settlement process; however, several obstacles were still identified, including incomplete claim documents, limited human resources under certain conditions, and suboptimal system performance. Variations in claim processing time were also found based on the type of care and type of insurance, influenced by document complexity and differences in insurance policies. Barriers in the claim process were predominantly caused by internal hospital factors, although external factors also contributed to delays. Overall, the non-JKN insurance claim settlement process at Universitas Indonesia Hospital has been implemented relatively well; however, improvements in claim document completeness, system optimization, and human resource management are still needed to improve efficiency and consistency in achieving the targeted claim processing time.