Key Responsibilities
- Handle cashless hospitalization requests and insurance claim processing.
- Verify patient insurance eligibility and policy coverage.
- Submit pre-authorization requests to TPAs and insurance companies.
- Coordinate with doctors, nursing staff, billing, and medical records departments for required documents.
- Prepare and submit final bills, discharge summaries, investigation reports, and other claim-related documents.
- Follow up with TPAs and insurance companies for approvals, queries, and claim settlements.
- Resolve claim discrepancies and respond to insurance queries promptly.
- Ensure accurate documentation and compliance with TPA and insurance guidelines.
- Coordinate with the billing department for insurance billing and claim reconciliation.
- Maintain records of approvals, rejections, pending claims, and settlements.
- Support patients by explaining insurance procedures, coverage, and documentation requirements.
- Prepare daily, weekly, and monthly reports on claims, approvals, rejections, and outstanding payments.
Qualifications
- Bachelor's degree in Commerce, Business Administration, Hospital Administration, Healthcare Management, or a related field.
- Certification in Health Insurance or Hospital Administration is an added advantage.
Experience
- 1–3 years of experience in hospital TPA operations, medical insurance, billing, or claims management.
- Freshers with relevant education may also be considered.
Required Skills
- Knowledge of health insurance, TPA processes, and cashless claim procedures.
- Understanding of hospital billing and medical documentation.
- Strong communication and coordination skills.
- Attention to detail and accuracy in documentation.
- Good problem-solving and follow-up skills.
- Proficiency in Hospital Information Systems (HIS), Microsoft Excel, and Microsoft Office.
- Ability to work under pressure and meet claim submission deadlines.
Key Performance Indicators (KPIs)
- Timely submission of pre-authorizations and claims.
- Claim approval and settlement rate.
- Reduction in claim rejections and document deficiencies.
- Turnaround time (TAT) for approvals and settlements.
- Accuracy of billing and claim documentation.
- Patient and insurance partner satisfaction.
Pay: ₹25,000.00 - ₹35,000.00 per month
Work Location: In person
