Job Title: Insurance Executive – Hospital OperationsLocation: [Insert Location]Experience: 1–5+ years (Hospital / Healthcare Insurance domain)Job Summary:
The Insurance Executive is responsible for managing end-to-end insurance processes within the hospital, including pre-authorization, patient coordination, claims processing, and liaison with TPAs (Third Party Administrators) and corporate clients such as Railways. The role ensures smooth billing, approvals, and timely claim settlements.
Key Responsibilities:1. Pre-Authorization (Preauth):
- Handle cashless hospitalization approvals from insurance companies and TPAs
- Submit accurate pre-authorization requests with required documents
- Follow up with insurers/TPAs for timely approvals and query resolution
- Coordinate with doctors and medical staff for clinical details
2. Front Office Insurance Desk:
- Guide patients regarding insurance policies, coverage, and procedures
- Verify insurance eligibility and documentation at admission
- Coordinate with patients/attenders for required approvals and forms
- Ensure proper communication regarding approvals, denials, and balances
3. Back Office Operations:
- Maintain and update patient insurance records and documentation
- Prepare case files for claim submission and audit compliance
- Handle data entry, tracking approvals, and maintaining MIS reports
- Ensure adherence to hospital and insurance protocols
4. Claims Processing:
- Prepare and submit final bills to TPAs/insurance companies
- Handle reimbursement and cashless claims efficiently
- Follow up for claim status, approvals, and settlements
- Manage claim rejections, discrepancies, and resubmissions
5. Railway & Corporate Claims Handling:
- Process claims related to Railway beneficiaries and other corporate tie-ups
- Ensure compliance with Railway medical claim policies and documentation
- Liaise with Railway departments and corporate offices for approvals
- Handle special billing formats and procedures as required
6. Coordination & Liaison:
- Act as a point of contact between hospital, TPAs, insurance companies, and patients
- Build and maintain good relationships with TPAs and corporate clients
- Stay updated on insurance policies, guidelines, and claim procedures
Required Skills:
- Strong knowledge of hospital insurance processes and TPA operations
- Familiarity with Railway claims procedures (preferred)
- Good communication and interpersonal skills
- Attention to detail and documentation accuracy
- Ability to handle multiple cases and meet deadlines
- Basic computer skills (MS Office, Hospital Information Systems)
Qualifications:
- Any Graduate (preferred: Healthcare Administration / Commerce / Life Sciences)
- Relevant certification in medical insurance or hospital administration is a plus
Preferred Experience:
- Experience handling TPAs such as Medi Assist, Star Health, FHPL, etc.
- Prior work in hospitals, nursing homes, or healthcare billing departments
[email protected]
9750972999
Pay: ₹15,000.00 - ₹20,000.00 per month
Work Location: In person
