Insurance Executive

We are seeking a dedicated Insurance Executive to manage insurance patient claims, coordinate with insurance companies and Third Party Administrators (TPAs), and ensure exceptional patient experience throughout the insurance claim process. The role focuses on facilitating seamless insurance services for patients undergoing cataract surgeries and other specialized eye care treatments.

Key Responsibilities

Insurance Claims Management

• Process and manage insurance claims for patients undergoing cataract surgeries, retinal procedures, corneal treatments, and other eye care services
• Ensure accurate completion of all claim documentation and submission within specified timelines
• Track claim status and follow up with insurance companies and TPAs for timely settlements
• Handle claim rejections, denials, and appeals processes effectively
• Maintain detailed records of all insurance transactions and communications

Pre-Authorization and Cashless Benefits

• Facilitate pre-authorization processes for planned procedures, especially cataract surgeries and major eye treatments
• Coordinate with insurance companies and TPAs to secure cashless treatment approvals
• Verify patient insurance coverage, policy limits, and benefit entitlements
• Ensure all required documentation is complete before treatment commencement
• Manage emergency authorization processes when required

Patient Relations and Support

• Serve as primary point of contact for patients regarding insurance-related queries and concerns
• Explain insurance benefits, coverage limitations, and claim processes to patients and their families
• Provide regular updates on claim status and expected settlement timelines
• Address patient complaints and concerns related to insurance matters promptly
• Ensure patient satisfaction throughout the insurance claim journey

Documentation and Compliance

• Maintain accurate and up-to-date patient insurance files and documentation
• Ensure compliance with insurance company requirements and hospital policies
• Prepare and submit required medical reports, discharge summaries, and billing documents
• Coordinate with medical records department for timely documentation
• Maintain confidentiality of patient information as per regulatory requirements

Stakeholder Coordination

• Liaise with insurance companies, TPAs, and brokers to resolve queries and expedite processes
• Coordinate with hospital departments including billing, medical records, and patient services
• Work closely with doctors and clinical staff to obtain necessary medical documentation
• Maintain positive relationships with insurance company representatives and TPA coordinators

Required Qualifications

Education

• Bachelor's degree in Commerce, Business Administration, or related field
• Additional certification in Insurance or Healthcare Administration preferred

Experience

• Minimum 2-3 years of experience in insurance claim processing, preferably in healthcare sector
• Experience with eye care or specialty hospital insurance operations is an advantage
• Knowledge of cashless treatment processes and pre-authorization procedures

Technical Skills

• Proficiency in insurance management software and hospital information systems
• Good understanding of medical terminology, especially related to ophthalmology
• Knowledge of various insurance policies, coverage types, and claim procedures
• Familiarity with TPA operations and processes

Core Competencies

• Strong communication skills in English, Malayalam and Tamil or Hindi
• Excellent organizational and time management abilities
• Detail-oriented with high accuracy in documentation
• Problem-solving skills and ability to handle complex insurance cases
• Customer service orientation with empathy for patients
• Ability to work under pressure and meet deadlines
• Professional demeanor and ethical conduct

Key Performance Indicators

• Claim processing turnaround time
• Pre-authorization approval rate
• Patient satisfaction scores for insurance services
• Claim settlement percentage and timeline
• Accuracy of documentation and minimal claim rejections
• Effective resolution of insurance-related patient complaints

Job Type: Full-time

Pay: ₹25,000.00 - ₹30,000.00 per month

Benefits:

• Cell phone reimbursement
• Provident Fund

Work Location: In person