- Clinical Scrutiny & Adjudication: Reviewing pre-authorization requests and claims to ensure medical necessity, proper ICD coding, and alignment with insurance policy terms.
- Billing & Dispute Resolution: Analyzing medical bills, managing implant reconciliations, and resolving billing discrepancies between the hospital and insurance TPAs.
- Team Leadership: Supervising, training, and evaluating TPA executives and medical officers to maintain high service standards.
- Liaison & Coordination: Serving as the primary point of contact between patients, attending doctors, insurance companies, and the hospital's billing department.
- Compliance: Ensuring strict adherence to regulatory guidelines (such as IRDAI rules) and internal hospital Standard Operating Procedures (SOPs).
- Education:
- MBBS, BAMS, or BHMS is highly preferred, often paired with a degree or diploma in Hospital Administration (MHA) or Healthcare Management.
- Experience: 1 to 5+ years of experience in medical claims processing, pre-authorization, and insurance coordination.
Pay: ₹30,000.00 - ₹40,000.00 per month
Work Location: In person
