Job Title: Mediclaim Insurance Coordinator
Department: TPA / Insurance
Reports To: Manager – Billing & Insurance / Hospital Administrator
Job Summary
The Mediclaim Insurance Coordinator is responsible for managing all health insurance and TPA (Third Party Administrator) processes, including cashless approvals, reimbursement claims, pre-authorizations, patient counseling, documentation, and coordination with insurance companies to ensure timely claim settlement and smooth patient discharge.
Key Responsibilities
- Verify patient insurance eligibility and policy coverage.
- Coordinate with TPAs and insurance companies for cashless admission approvals.
- Process pre-authorization, enhancement requests, and final authorization.
- Collect, verify, and submit all required claim documents.
- Coordinate with doctors, nursing, medical records, billing, and accounts departments for claim-related documentation.
- Track pending approvals and follow up with insurers/TPAs for timely responses.
- Handle reimbursement claim documentation and guide patients on submission procedures.
- Resolve insurance queries, claim rejections, deductions, and deficiencies.
- Ensure accurate billing as per insurer and TPA guidelines.
- Maintain insurance records, approval trackers, and daily MIS reports.
- Coordinate discharge clearance after insurance approval.
- Educate patients and attendants regarding policy coverage, exclusions, and payment liabilities.
- Ensure compliance with hospital policies, IRDAI guidelines, and insurer requirements.
- Maintain confidentiality of patient information and insurance records.
Required Qualifications
- Bachelor's degree in any discipline (B.Com, BBA, B.Sc., Hospital Administration preferred).
- Certification in Hospital Administration or Medical Insurance is an added advantage.
Experience
- Fresher to 3 years of experience in hospital TPA/insurance coordination.
- Knowledge of cashless and reimbursement claim processes is preferred.
Skills Required
- Knowledge of health insurance and TPA procedures.
- Medical terminology and hospital billing knowledge.
- Strong documentation and record-keeping skills.
- Excellent communication and patient counseling skills.
- Proficiency in MS Office and Hospital Information Systems (HIS).
- Good negotiation, coordination, and problem-solving abilities.
- Attention to detail and ability to work under pressure.
Key Performance Indicators (KPIs)
- Timely processing of pre-authorizations and final claims.
- Reduction in claim rejections and deductions.
- Turnaround time (TAT) for insurance approvals.
- Accuracy of documentation.
- Patient satisfaction with insurance services.
- Timely discharge of insured patients.
Pay: ₹16,000.00 - ₹23,000.00 per month
Work Location: In person
