Position
Insurance Coordinator
Department
Insurance / Billing
Reports To - HR Manager
Job Summary
The Insurance Coordinator is responsible for managing all insurance-related activities, including cashless authorization, pre-authorization, claim documentation, coordination with insurance companies/TPAs, patient counseling regarding insurance coverage, and ensuring timely claim submission and settlement while complying with hospital policies and insurer guidelines.
Key ResponsibilitiesInsurance & TPA Coordination
- Coordinate with insurance companies and TPAs for cashless treatment approvals.
- Submit pre-authorization requests with complete supporting documents.
- Follow up on pending approvals and communicate status to patients and clinicians.
- Ensure timely claim submission and reimbursement processing.
Documentation
- Verify patient insurance eligibility and policy coverage.
- Collect and maintain all required documents, including ID proofs, insurance cards, medical records, investigation reports, and discharge summaries.
- Ensure documentation is complete, accurate, and compliant with insurer requirements.
- Maintain confidential patient records.
Billing & Claims
- Coordinate with the billing department to prepare accurate final bills.
- Reconcile approved amounts with hospital billing.
- Track claim status and resolve claim rejections, deductions, and queries.
- Maintain records of submitted, approved, pending, and rejected claims.
Patient Coordination
- Explain insurance processes, coverage, exclusions, and patient liabilities.
- Assist patients in completing insurance-related forms.
- Address patient queries regarding cashless and reimbursement claims.
Coordination with Internal Departments
- Work closely with doctors, nursing staff, medical records, billing, and front office.
- Ensure all required clinical documents are obtained on time for claim processing.
Reporting
- Prepare daily and monthly reports on insurance cases.
- Monitor turnaround time (TAT) for approvals and claim settlements.
- Report pending claims and outstanding issues to management.
Qualifications
- Bachelor's Degree in any discipline (Healthcare Administration, Commerce, or Business Administration preferred).
- Certification or experience in Medical Insurance/TPA coordination is an added advantage.
Experience
- Minimum 2 years of experience in hospital insurance/TPA coordination.
- Experience in a multi-speciality hospital preferred.
Required Skills
- Knowledge of health insurance policies, TPAs, and cashless claim processes.
- Familiarity with hospital billing systems and medical terminology.
- Strong communication and interpersonal skills.
- Good documentation and organizational skills.
- Proficiency in MS Office and Hospital Information Systems (HIS).
- Ability to work under pressure and meet deadlines.
Key Competencies
- Attention to detail.
- Problem-solving ability.
- Customer service orientation.
- Teamwork and coordination.
- Time management.
- Professional ethics and confidentiality.
Working Hours
As per hospital shift policy, including weekends and holidays if required.
This requirement is for 30 bedded hospital and the salary will be finalised based on your experience and expertise.
Pay: ₹20,000.00 - ₹30,000.00 per month
Benefits:
- Cell phone reimbursement
- Flexible schedule
- Paid sick time
- Paid time off
- Provident Fund
Work Location: In person
