Education qualification ------ B.E / B-TECH , CS, ECE, EEE, BIO MEDICAL MEG. IT
Strong computer skills email drafting
1. Job Purpose
To coordinate and manage insurance and cashless hospitalization processes, ensuring timely pre-authorisation, documentation, claim submission, follow-up, and settlement of insurance claims.
2. Key Responsibilities
- Coordinate cashless admission and discharge processes for insurance patients.
- Verify patient insurance details, eligibility, policy coverage, and required documents.
- Coordinate with insurance companies, TPAs, and corporate clients.
- Prepare and submit pre-authorisation requests with complete medical documents.
- Follow up on pending pre-authorisation and enhancement requests.
- Coordinate with doctors and clinical departments for required medical reports and clarifications.
- Ensure accurate documentation for cashless and reimbursement claims.
- Prepare and submit final bills and claim documents to the concerned TPA/insurance company.
- Follow up on pending, queried, rejected, and settled claims.
- Coordinate with the billing and accounts departments for claim-related issues.
- Maintain records of insurance patients, approvals, claims, deductions, and settlements.
- Monitor TPA/insurance portal updates and respond to queries within the required time.
- Identify claim discrepancies and coordinate for corrections.
- Communicate with patients and relatives regarding insurance procedures, approvals, deductions, and non-payable amounts.
- Ensure proper collection of documents such as insurance card, ID proof, policy details, medical reports, discharge summary, and bills.
- Maintain confidentiality of patient and insurance information.
- Prepare daily/weekly/monthly insurance reports for management.
- Support the hospital during insurance audits and claim-related inspections.
- Ensure compliance with hospital policies, insurance/TPA requirements, and applicable regulatory requirements.
3. Required Skills
- Good knowledge of hospital insurance and TPA procedures.
- Good communication and coordination skills.
- Basic knowledge of medical terminology and hospital billing.
- Computer proficiency and knowledge of MS Office/Excel.
- Ability to work with insurance/TPA portals.
- Good documentation and follow-up skills.
- Ability to handle patients and insurance representatives professionally.
- Good numerical and analytical skills.
4. Educational Qualification
Minimum: Any Degree / Diploma.
Preferred: Hospital Administration, Healthcare Management, Insurance, Commerce, or related qualification.
5. Experience
Preferred: 1–3 years of experience in hospital insurance, TPA, billing, or healthcare administration.
6. Key Performance Indicators (KPIs)
- Timely pre-authorisation submission.
- Timely claim submission.
- Reduction in claim rejections and queries.
- Timely follow-up of pending claims.
- Accuracy of insurance documentation.
- Insurance claim settlement percentage.
- Patient satisfaction regarding insurance coordination.
- Reduction in claim processing delays.
7. Personal Attributes
- Responsible and detail-oriented.
- Patient and professional in dealing with patients.
- Good teamwork and coordination.
- Ability to work under pressure.
- Strong follow-up and problem-solving ability.
- Honest and maintains confidentiality.
Pay: ₹12,000.00 - ₹18,000.00 per month
Benefits:
Work Location: In person
