Key Responsibilities:
- Verify patient insurance eligibility and policy details.
- Coordinate with TPAs and insurance companies for cashless pre-authorization and approvals.
- Collect, review, and submit all required claim documents accurately and on time.
- Follow up on pending approvals, queries, and claim settlements.
- Explain insurance procedures, coverage, exclusions, and required documents to patients and their attendants.
- Maintain accurate records of insurance claims, approvals, rejections, and settlements.
- Coordinate with doctors, nursing staff, billing, MRD, and other departments for claim-related documentation.
- Ensure compliance with hospital policies and insurance/TPA guidelines.
- Resolve claim-related issues and respond promptly to insurance queries.
- Prepare daily, weekly, and monthly insurance claim reports.
- Monitor outstanding claims and ensure timely closure.
- Assist in internal and external audits related to insurance documentation.
- Maintain confidentiality of patient information and insurance records.
Qualifications:
- Bachelor's Degree in any discipline (Healthcare Administration or Hospital Management preferred).
- Experience in hospital insurance/TPA operations is preferred.
- Freshers with relevant knowledge may also apply.
Skills Required:
- Knowledge of health insurance and TPA claim processes.
- Good communication and interpersonal skills.
- Computer proficiency (MS Office and Hospital Information System).
- Strong documentation and organizational skills.
- Attention to detail and accuracy.
- Ability to work under pressure and meet deadlines.
- Problem-solving and coordination skills.
Working Conditions:
- Hospital-based role with rotational shifts, if required.
- May require coordination with multiple departments and insurance representatives.
Key Performance Indicators (KPIs):
- Timely cashless authorization processing.
- Claim submission accuracy.
- Claim settlement turnaround time.
- Reduction in claim rejections.
- Patient satisfaction with insurance services.
- Compliance with documentation standards.
- Timely submission of reports.
Pay: ₹15,000.00 - ₹20,000.00 per month
Work Location: In person
