A Claims Coordinator in a hospital/healthcare insurance department is responsible for coordinating the complete insurance claim process—from patient admission and cashless approval to final settlement and payment follow-up. Key Responsibilities Insurance Claim Processing Coordinate cashless and reimbursement claims. Verify patient insurance details, policy eligibility, and required documents. Ensure claims are submitted within the prescribed TAT. Track claims from submission to final settlement. Pre-Authorization & Cashless Coordinate pre-authorization requests with TPAs/insurance companies. Submit required medical documents, estimates, investigation reports, and treatment details. Follow up for approval, enhancement, and final discharge authorization. Coordinate with doctors and billing teams for insurance queries. Claim Documentation Ensure complete and accurate claim documentation. Verify discharge summary, final bill, prescriptions, investigation reports, referral letters, ID proof, and other required documents. Upload documents on TPA/insurance portals. Arrange and submit hard copies wherever required. Claim Follow-up Regularly follow up on pending claims, queries, shortfalls, and rejected claims. Coordinate with TPAs and insurance companies for claim status. Maintain claim-wise follow-up records. Escalate delayed or critical claims to the appropriate team.
Pay: ₹15,000.00 - ₹20,000.00 per month
Benefits:
- Cell phone reimbursement
- Paid sick time
Work Location: In person
