Insurance Executive

The Insurance Coordinator is responsible for managing all activities related to patient insurance processing within the hospital. This includes handling pre-authorizations, insurance claims submission, approvals, follow-ups with TPAs/insurance companies, and ensuring timely reimbursements. The role is key to revenue cycle efficiency and patient satisfaction.

Key Responsibilities:

• Pre-Authorization & Approvals
• Obtain pre-authorizations from insurance companies/TPAs for surgeries, procedures, and admissions.
• Ensure all necessary documentation (consultation notes, investigation reports, etc.) is attached with pre-auth requests.
• Coordinate with medical and nursing staff to facilitate timely documentation.
• Claims Processing
• Prepare and submit insurance claims (cashless and reimbursement) in a timely and accurate manner.
• Scrutinize medical bills and discharge summaries for completeness and correctness before submission.
• Track claims status regularly and follow up with insurance/TPA teams for pending approvals.
• Billing Coordination
• Coordinate with billing and finance teams to ensure accurate mapping of insurance policies and packages.
• Verify policy validity, coverage limits, exclusions, and co-payments.
• Guide patients/families regarding their insurance eligibility and coverage.
• TPA & Insurance Communication
• Serve as the primary point of contact between the hospital and insurance/TPA representatives.
• Maintain cordial and professional relationships with all external parties.
• Resolve claim denials or discrepancies through negotiation and documentation support.
• Documentation & Compliance
• Ensure proper documentation of all communications, approvals, and claim-related records.
• Maintain patient insurance files and databases with confidentiality.
• Stay updated with changes in insurance guidelines, IRDA norms, and hospital policy.
• Reporting
• Generate periodic reports on claim status, TAT, pending amounts, rejected claims, and collection trends.
• Escalate delays and bottlenecks to management as necessary

Working Conditions:

• Full-time, based in the hospital premises
• May involve shift duties (depending on hospital operations)
• Interaction with patients, doctors, and third-party representatives
• Teamwork and interdepartmental coordination
• Ethical and transparent work practices
• Problem-solving and analytical thinking

Job Types: Full-time, Permanent, Fresher

Pay: From ₹15,000.00 per month

Work Location: In person