Job Summary
The Insurance Manager is responsible for overseeing all insurance and TPA (Third Party Administrator) operations within the hospital. The role involves managing insurance claims, coordinating with insurance companies and TPAs, ensuring timely approvals, reducing claim rejections, and maintaining compliance with insurance policies and hospital procedures.
Key ResponsibilitiesInsurance & TPA Management
- Coordinate with insurance companies and TPAs for patient cashless and reimbursement claims.
- Ensure timely submission of pre-authorization requests and required documents.
- Follow up on pending approvals and claim settlements.
- Maintain strong relationships with insurance providers and TPAs.
Claims Processing
- Verify insurance eligibility and coverage details of patients.
- Review and process insurance claims accurately.
- Monitor claim status and resolve claim-related issues.
- Minimize claim rejections through proper documentation and compliance.
Patient Coordination
- Guide patients and attendants regarding insurance procedures and requirements.
- Address insurance-related queries and concerns.
- Ensure smooth cashless admission and discharge processes.
Documentation & Compliance
- Maintain accurate records of all insurance transactions and claims.
- Ensure compliance with insurance regulations, hospital policies, and TPA guidelines.
- Conduct periodic audits of insurance files and records.
Team Management
- Supervise insurance coordinators and billing staff.
- Provide training on insurance processes and policy updates.
- Monitor team performance and ensure service quality.
Reporting
- Prepare daily, weekly, and monthly insurance reports.
- Analyze claim approval, rejection, and settlement trends.
- Present insurance performance reports to management.
Benefits:
Work Location: In person
