Mediclaim Cashless Executive

Their key responsibilities include:

· Verifying Eligibility and Coverage: Confirming a patient's insurance coverage, policy details, and eligibility for cashless treatment before or at the time of admission.

· Facilitating Pre-authorization: Assisting the patient (or hospital staff on their behalf) in filling out and submitting the necessary pre-authorization forms and documents to the insurer or TPA to get approval for the treatment.

· Documentation Management: Ensuring all required documentation—including the pre-authorization form, ID proof, health card, medical records, bills, and discharge summaries—is accurate, complete, and submitted within stipulated timeframes to avoid claim rejections.

· Liaising and Communication: Acting as the main point of contact, communicating effectively with patients, doctors, hospital departments, TPA and insurance companies to resolve any discrepancies, answer inquiries, provide claim status updates, and ensure a smooth flow of information.

· Claim Processing and Settlement: Reviewing claims, applying medical coding principles (if applicable), and coordinating with the insurer/TPA to ensure the approved amount is settled directly with the hospital. The executive helps ensure timely processing, with regulatory bodies mandating quick approval times (e.g., within 1 hour for pre-authorization and 3 hours for discharge authorization).

· Billing Coordination: Assisting with the final billing and discharge process, clarifying to the patient which expenses are covered by the policy and which (non-medical expenses, co-payments, amounts exceeding the sum insured) need to be paid out-of-pocket.

· Compliance and Reporting: Ensuring all processes comply with insurance regulations, company policies, and healthcare laws, as well as preparing and maintaining daily reports related to insurance activities.

Job Type: Full-time

Pay: ₹20,000.00 - ₹25,000.00 per month

Work Location: In person