Insurance Executive / Insurance Coordinator
Department
******Hospitals side experience minimum 3 years*****
TPA / Insurance Department
Reports To
HR Manager / Operations Manager / Hospital Administrator
Job Summary
The Insurance Executive is responsible for coordinating cashless and reimbursement insurance processes, obtaining pre-authorizations, communicating with insurance companies and TPAs, ensuring timely claim submission, and supporting patients throughout the insurance process.
Key ResponsibilitiesPatient Coordination
- Explain insurance procedures to patients and attendants.
- Verify insurance eligibility and policy details.
- Collect required documents from patients.
Cashless Processing
- Initiate pre-authorization requests.
- Coordinate with TPAs and insurance companies for approvals.
- Follow up on pending approvals.
- Inform patients and doctors about approval status.
Reimbursement Processing
- Guide patients regarding reimbursement claims.
- Prepare complete discharge document sets.
- Ensure all required documents are accurate before submission.
Documentation
- Verify patient identity documents.
- Maintain insurance files and digital records.
- Ensure complete documentation as per TPA requirements.
- Maintain confidentiality of patient information.
Billing & Claims
- Coordinate with billing department.
- Verify approved package and billing details.
- Submit final claims within timelines.
- Follow up for claim settlement.
Communication
- Liaise with insurance companies, TPAs, corporate clients, and doctors.
- Coordinate with nursing, billing, medical records, and pharmacy departments.
Reporting
- Prepare daily insurance admission reports.
- Maintain pending claim reports.
- Submit monthly insurance performance reports.
- Track approval and rejection status.
Compliance
- Follow hospital policies and NABH standards.
- Ensure accurate documentation to minimize claim rejections.
- Maintain patient confidentiality.
Qualification
- Any Bachelor's Degree (B.Com, BBA, B.Sc, BCA, etc.)
- Preferred: MBA (Hospital Administration/HR) or Hospital Administration.
Experience
- 1–3 years in hospital insurance/TPA coordination.
- Freshers with hospital internship may also be considered.
Skills Required
- Knowledge of TPA and health insurance processes.
- Good communication skills.
- Computer proficiency (MS Excel, Word, Hospital Information System).
- Documentation and record management.
- Time management and multitasking.
- Problem-solving and negotiation skills.
Key Performance Indicators (KPIs)
- Cashless approval turnaround time.
- Number of claims processed.
- Claim settlement percentage.
- Claim rejection rate.
- Patient satisfaction.
- Accuracy of documentation.
- Timely submission of insurance claims.
Pay: ₹8,086.00 - ₹20,000.00 per month
Benefits:
Work Location: In person
