Job Summary
We are looking for a highly experienced and detail-oriented Senior Insurance Executive to manage hospital insurance operations, including cashless approvals, claim processing, reimbursement cases, and coordination with Insurance Companies and TPAs. The ideal candidate should possess strong knowledge of health insurance processes, claim documentation, and hospital billing systems while ensuring timely claim settlements and excellent patient support.
Key Responsibilities
- Handle end-to-end insurance operations for inpatient and outpatient services.
- Coordinate with Insurance Companies and TPAs for cashless approvals, pre-authorizations, and claim settlements.
- Verify patient insurance eligibility, policy coverage, and required documentation.
- Process cashless and reimbursement claims accurately within the prescribed timelines.
- Follow up on pending approvals, claim rejections, denials, and settlement issues.
- Ensure accurate preparation and submission of insurance claim documents.
- Coordinate with consultants, nursing, billing, medical records, and finance teams to obtain required documents.
- Resolve insurance-related patient queries professionally and efficiently.
- Maintain proper records of insurance claims, approvals, settlements, and outstanding cases.
- Monitor aging reports and ensure timely closure of pending claims.
- Ensure compliance with hospital policies, TPA guidelines, insurance regulations, and statutory requirements.
- Generate daily, weekly, and monthly MIS reports related to insurance operations.
- Support internal and external audits by maintaining complete and accurate documentation.
- Guide and mentor junior insurance executives whenever required.
- Maintain confidentiality of patient information and insurance records.
Required Qualifications
- Bachelor's Degree in Commerce, Business Administration, Healthcare Management, or any relevant discipline.
- Certification in Health Insurance, Medical Billing, or Hospital Administration will be an added advantage.
Experience
- Mandatory: 3–5 years of experience in Hospital Insurance Operations.
- Hands-on experience in cashless authorization, insurance claim processing, reimbursement claims, and TPA coordination.
- Experience working with Hospital Information Systems (HIS) and insurance portals.
Required Skills
- Strong knowledge of hospital insurance processes and claim management.
- Expertise in handling TPAs, corporate insurance, and private insurance companies.
- Good understanding of pre-authorization, enhancement requests, discharge approvals, and final settlements.
- Excellent communication, negotiation, and interpersonal skills.
- Strong analytical and problem-solving abilities.
- Proficiency in MS Excel and Hospital Information Systems (HIS).
- Ability to work under pressure and meet strict timelines.
Key Competencies
- Customer Service Orientation
- Attention to Detail
- Time Management
- Team Collaboration
- Problem Solving
- Accountability & Integrity
- Process and Quality Focus
Preferred Candidate Profile
- Hospital Experience is Mandatory.
- Ability to independently manage insurance operations with minimal supervision.
- Strong knowledge of insurance documentation, TPA guidelines, and healthcare regulations.
- Immediate joiners will be preferred.
Contact: 9994255121 / 8754010369
Email: [email protected]
Pay: From ₹25,000.00 per month
Benefits:
Work Location: In person
