JOB DESCRIPTION
Job Title
Health Insurance Executive / Insurance Coordinator
Department
Insurance / Billing / Administration
Job Summary
The Health Insurance Executive is responsible for coordinating insurance-related activities for patients, including insurance verification, pre-authorization, claim processing, documentation, follow-up, and coordination with insurance companies and Third-Party Administrators (TPAs).
Key Responsibilities
- Verify patient insurance eligibility and policy details.
- Explain insurance procedures, coverage, exclusions, and required documents to patients and their attendants.
- Coordinate cashless admission and treatment procedures with insurance companies/TPAs.
- Prepare and submit pre-authorization requests with accurate medical and patient details.
- Coordinate with doctors, nursing staff, billing, medical records, and administration for required documents.
- Follow up on pre-authorization approvals and queries from insurance companies/TPAs.
- Prepare and submit insurance claims within the required timelines.
- Ensure claim documents are complete, accurate, and properly arranged.
- Track pending, approved, rejected, and settled claims.
- Follow up on claim rejections, deductions, queries, and resubmissions.
- Maintain proper records of all insurance patients and claims.
- Coordinate discharge authorization and final bill submission.
- Communicate professionally with insurance companies, TPAs, patients, and hospital departments.
- Maintain confidentiality of patient and insurance-related information.
- Prepare daily/weekly/monthly insurance reports for management.
- Ensure compliance with hospital policies and applicable insurance procedures.
- Perform any other insurance-related duties assigned by management.
Required Skills
- Good communication and interpersonal skills.
- Basic knowledge of health insurance and TPA procedures.
- Knowledge of cashless hospitalization and claim processing.
- Good computer skills, especially MS Word and Excel.
- Strong documentation and follow-up skills.
- Ability to coordinate with multiple departments.
- Good attention to detail.
- Ability to work under pressure and meet deadlines.
Educational Qualification
Minimum: Any Degree / Diploma
Preferred: Experience in hospital insurance, billing, TPA coordination, or healthcare administration.
Experience
Preferred: 1–3 years of experience in hospital insurance/TPA coordination or medical billing.
Working Relationship
Reports To: Hospital Administration / HR / Accounts Manager
Coordinates With:
Doctors Nursing Department Billing Medical Records Pharmacy Administration Insurance Companies TPAs
Performance Indicators
- Timely submission of pre-authorization requests.
- Timely claim submission and processing.
- Reduction in claim rejection and documentation errors.
- Effective follow-up of pending claims.
- Accurate maintenance of insurance records.
- Patient satisfaction and effective coordination.
Pay: ₹15,000.00 - ₹25,000.00 per month
Benefits:
- Cell phone reimbursement
- Flexible schedule
- Food provided
- Leave encashment
Work Location: In person
