Insurance Executive

KEY INTERNAL INTERACTION WITH

NATURE OF INTERACTION

· Accounts & Finance

Submitting and following up of claims settlement and maintaining claims MIS with settlement details

· Operations

Managing front office staff for Govt. credit business- ESI/ECHS /Govt. Schemes and facilitating for the cashless provisions to patients as per eligibility and norms.

Assemble and maintain patient records, review transcriptions and interact with Physicians to ensure all relevant patient information are recorded for submission to authorities.

Coordinating cashless request/medical query/Arbitration with medical teams- both internal and external

Ensuring for approvals on credit facility for scheme patients and settlement after final approval/claim payment receipts.

Maintaining MIS of credit patients including admissions/cashless/submissions/payment settlement status

Ensure timely preparation of claim document and submission with respective authorities.

Managing the timely revert on medical/nonmedical /financial queries on submitted cashless claims

Coordinating for the surgery/OT clearance based on initial approvals or advance /deposits.

Obtaining patient feedback from credit patients & tie up departments

KEY EXTERNAL INTERACTION WITH

NATURE OF INTERACTION

· Patients/ Insurance Co./TPAS/ESI/ECHS /Medical Team

Answering Patient Billing queries, work with patients and government authorities to get claim processed and paid.

Liaisoning with Insurance authorities for claim payments/queries/rejection/arbitrations

Objective

This role incumbent is responsible is to work closely with the Insurance /ESI/ECHS/Beneficiaries to ensure timely processing of cashless admissions and submission/settlement of Cashless claims

Key Responsibilities

1 Preparation & Processing of Health Insurance/ Cashless Claims

· Submitting and following up of claims, creating and Managing cashless Patient files including admission requests/extended stay approvals/Additional approvals etc.

· Reviewing & appealing unsettled patient claims - Query & Arbitration Management

· Adherence to TAT of admissions , approvals and bill submission & settlement

2 Operational Activities

· Facilitating for Account receivable reports and coordinate with finance/TRM for account receivables management

· Provide feedback of claims status to the reporting officer on a daily/weekly basis

Job Type: Full-time

Pay: ₹12,000.00 - ₹15,000.00 per month

Benefits:

• Cell phone reimbursement

Experience:

• total work: 1 year (Preferred)

Work Location: In person

Expected Start Date: 01/09/2025