Insurance Executive
Reports To Manager – Insurance
Job Summary
The Insurance Executive is responsible for managing all health insurance and Third-Party Administrator (TPA) processes for patients. The role involves coordinating with insurance companies and TPAs for pre-authorizations, cashless approvals, reimbursement claims, claim settlements, and documentation while ensuring timely and accurate processing of insurance cases. The executive acts as a liaison between patients, clinicians, billing, MRD, and insurance providers to facilitate seamless patient care and revenue collection.
Key ResponsibilitiesInsurance & TPA Coordination
- Process cashless hospitalization requests and reimbursement claims.
- Verify patient insurance eligibility, policy coverage, and authorization requirements.
- Submit pre-authorization requests with complete and accurate documentation.
- Coordinate with insurance companies and TPAs for approvals and claim settlements.
- Follow up on pending approvals, denials, and claim queries.
Documentation & Claims Management
- Collect and verify all required clinical and billing documents.
- Coordinate with consultants, nursing, billing, pharmacy, laboratory, radiology, and MRD to obtain supporting documents.
- Ensure timely submission of final claim documents.
- Maintain complete and accurate insurance records for every patient.
- Monitor claim status until settlement and closure.
Billing & Patient Support
- Coordinate with the billing department to ensure accurate insurance billing.
- Assist patients and their attendants in understanding insurance benefits, exclusions, and claim procedures.
- Resolve insurance-related queries professionally and promptly.
- Facilitate smooth discharge of insured patients by obtaining final approvals.
Reporting & Compliance
- Maintain daily, weekly, and monthly MIS reports on insurance cases, approvals, pending claims, rejections, and settlements.
- Ensure compliance with hospital policies, TPA guidelines, insurance regulations, and documentation standards.
- Support internal and external audits related to insurance claims.
- Maintain confidentiality of patient information in accordance with hospital policies.
Qualifications
- Bachelor's Degree in Hospital Administration, Healthcare Management, Commerce, Business Administration, or any relevant discipline.
- MHA/MBA (Hospital Administration) will be an added advantage.
Experience
- 1–3 years of experience in hospital insurance, TPA coordination, or medical claims processing.
- Freshers with relevant hospital administration qualifications may be considered based on organizational requirements.
Required Skills
- Knowledge of health insurance, cashless claims, reimbursement claims, and TPA procedures.
- Familiarity with Hospital Information Systems (HIS).
- Proficiency in MS Office (Excel, Word, Outlook).
- Understanding of medical terminology and hospital billing.
- Excellent communication and interpersonal skills.
- Strong documentation and record-keeping ability.
- Good analytical and problem-solving skills.
- Ability to work under pressure and meet deadlines.
- High level of accuracy, integrity, and confidentiality.
Key Competencies
- Customer Service Orientation
- Attention to Detail
- Time Management
- Coordination & Follow-up
- Teamwork
- Decision Making
- Professional Ethics
- Organizational Skills
Key Performance Indicators (KPIs)
- Turnaround time for pre-authorizations.
- Percentage of claims approved on first submission.
- Reduction in claim rejections and denials.
- Timely claim submission and settlement.
- Accuracy of insurance documentation.
- Patient satisfaction with insurance services.
- Compliance with hospital and insurance policies.
Job Type: Full-time
Pay: From ₹15,000.00 per month
Work Location: In person
