Job Summary
The Insurance Executive is responsible for coordinating with insurance companies and TPAs, processing cashless and reimbursement claims, ensuring proper documentation, obtaining timely approvals, and facilitating smooth insurance-related services for patients.
Key Responsibilities
- Coordinate with insurance companies and TPAs for cashless and reimbursement claims.
- Verify patient insurance eligibility and policy coverage.
- Collect and review all required documents for insurance processing.
- Submit pre-authorization requests and follow up for approvals.
- Coordinate with doctors, nursing staff, billing, MRD, and other departments to obtain required medical documents.
- Ensure timely submission of claim documents to insurance companies/TPAs.
- Maintain accurate records of insurance cases, approvals, rejections, and pending claims.
- Prepare insurance bills as per hospital and insurance guidelines.
- Respond to insurance and TPA queries promptly.
- Follow up on pending claims and reimbursement status.
- Resolve insurance-related issues and patient queries professionally.
- Ensure compliance with hospital policies and insurance regulations.
- Generate daily, weekly, and monthly insurance reports.
- Maintain confidentiality of patient information and medical records.
Qualification
- Bachelor's Degree in any discipline (preferred: Healthcare Management, Commerce, Business Administration, or Hospital Administration).
- Certification in Health Insurance or Hospital Administration is an added advantage.
Experience
- 1–3 years of experience in hospital insurance/TPA coordination.
- Freshers with relevant healthcare knowledge may also be considered.
Required Skills
- Knowledge of health insurance and TPA processes.
- Good communication and interpersonal skills.
- Basic knowledge of medical terminology.
- Proficiency in MS Office and Hospital Information Systems (HIS).
- Strong documentation and record-keeping skills.
- Good coordination and follow-up abilities.
- Ability to work under pressure and meet deadlines.
- Problem-solving and customer service skills.
- Attention to detail and accuracy.
Key Performance Indicators (KPIs)
- Timely insurance pre-authorization approvals.
- Reduction in claim rejections.
- Timely claim submission and follow-up.
- Accuracy of documentation.
- Patient satisfaction with insurance services.
- Effective coordination with internal departments and TPAs.
Pay: ₹15,000.00 - ₹20,000.00 per month
Work Location: In person
