Insurance Executive

Insurance Coordination & Verification

• Verify patient insurance eligibility, coverage, and policy terms before admission or procedures.
• Ensure accurate documentation from patients for insurance processing.
• Coordinate with consultants and departments to prepare required documents for authorization.

2. Pre-Authorization & Approvals

• Initiate and obtain pre-authorization from insurance companies/TPAs for planned and emergency procedures.
• Track and maintain records of all approvals, queries, and status updates.
• Follow up promptly on pending or delayed authorizations.

3. Claims Processing & Submission

• Prepare and submit insurance claims with complete and accurate documentation.
• Review bills, case sheets, discharge summaries, and investigation reports for correctness.
• Ensure claims are submitted within the stipulated time frame.

4. TPA / Insurance Company Coordination

• Liaise with TPA representatives and insurance officers for approvals, queries, and claim clarifications.
• Maintain professional relationships to ensure seamless coordination.
• Attend audits and provide required case documents promptly.

5. Discharge & Billing Support

• Coordinate with billing and medical records teams to ensure proper coding and documentation.
• Provide insurance estimates to patients and update them regarding insurance deductions, exclusions, and coverage.
• Assist in final bill settlement for insured patients.

6. Claim Follow-up & Reconciliation

• Track claim status, resubmissions, and payment follow-ups.
• Handle claim rejections/denials, rectify discrepancies, and coordinate for reprocessing.
• Prepare monthly reconciliation reports on claims submitted, approved, rejected, and pending.

7. Compliance & Documentation

• Ensure all insurance processes comply with hospital policies, IRDAI norms, and TPA guidelines.
• Maintain secure and organized documentation for audits and verification purposes.
• Update management on changes in insurance policies, tariffs, and TPA requirements.

Job Type: Full-time

Pay: ₹20,000.00 - ₹30,000.00 per month

Benefits:

• Health insurance
• Leave encashment
• Paid sick time
• Provident Fund

Education:

• Bachelor's (Preferred)

Experience:

• Insurance department (Hospital): 5 years (Preferred)

Language:

• Tamil. English (Preferred)

Work Location: In person