who can handle Government insurance like ECHS , CGHS, CM Scheme ,new insurance TPA empanelment, payment follow-ups, and all backend insurance-related work efficiently.
1. Insurance Verification
- Verify patient insurance eligibility and policy coverage
- Check:
- Sum insured
- Room rent eligibility
- Co-pay clauses
- Waiting periods
- Exclusions
- Coordinate with insurance companies or TPAs before admission
2. Cashless Authorization Processing
- Prepare and submit pre-authorization requests for cashless treatment
- Upload/send:
- Doctor notes
- Investigation reports
- Treatment estimates
- Follow up with TPAs/insurers for approval status
3. Claims Documentation
- Collect and verify all required documents:
- Discharge summary
- Bills
- Prescriptions
- Lab reports
- ID proofs
- Insurance forms
- Ensure documentation accuracy to avoid claim rejection
4. Coordination With Departments
- Work closely with:
- Front office
- Billing department
- Doctors
- Nursing staff
- Medical records team
- Ensure smooth insurance processing during patient stay and discharge
5. Handling Rejections & Queries
- Resolve claim denials or deductions
- Respond to insurer/TPA queries
- Re-submit corrected documents when required
6. Billing & Financial Reconciliation
- Match approved claim amount with hospital billing
- Inform patients about:
- Non-payable items
- Co-payment amounts
- Additional payments
- Maintain claim settlement records
7. Patient Support
- Explain insurance procedures to patients and attendants
- Guide patients regarding:
- Cashless process
- Reimbursement claims
- Required documents
- Approval timelines
8. Data Management & Reporting
- Maintain insurance records and MIS reports
- Track:
- Pending claims
- Approval rates
- Rejections
- Settlement timelines
- Update hospital software/HMIS systems
Skills RequiredTechnical Skills
- Knowledge of:
- Health insurance policies
- TPA procedures
- Medical terminology
- Hospital billing systems
- MS Excel & hospital software
Soft Skills
- Communication skills
- Coordination and follow-up ability
- Attention to detail
- Problem-solving
- Patience with patients and insurers
Pay: ₹18,000.00 - ₹35,000.00 per month
Work Location: In person
