Insurance Manager

Role & responsibilities

• Coordinate with all TPAs and insurance companies for cashless and reimbursement claims.
  
• Follow up for enhancement approvals during treatment and resolve TPA queries immediately.
  
• Manage final authorization and discharge approval process without delay.
  
• Verify patient eligibility, policy coverage, exclusions, room rent compliance, and package details.
  
• Coordinate with billing department to ensure accurate estimation and final bill preparation.
  
• Ensure proper documentation: discharge summary, investigation reports, bills, and claim forms.
  
• Reduce claim rejections by ensuring 100% accuracy in documents and coding.
  
• Maintain daily MIS reports on cashless approvals, pending cases, rejections, and follow-ups.
  
• Handle patient counseling regarding policy coverage, approval status, and required documents.
  
• Ensure compliance with hospital insurance SOPs and audit requirements.