Insurance executive

Patient & Insurance Coordination

• Explain insurance procedures, coverage, exclusions, and documentation requirements to patients and attendants.
• Verify patient insurance eligibility, policy details, and coverage limits at the time of admission.
• Assist patients in completing insurance forms and consent documents.

Cashless & Claim Processing

• Prepare and submit cashless pre-authorization requests to TPAs/insurance companies.
• Follow up on approvals, denials, and enhancements in a timely manner.
• Coordinate with treating doctors, billing department, and nursing staff for required medical documents.
• Prepare and submit final claims with accurate bills, discharge summaries, investigation reports, and prescriptions.

Documentation & Compliance

• Ensure completeness and accuracy of all insurance-related documents.
• Maintain proper records of submitted, approved, rejected, and pending claims.
• Ensure compliance with hospital policies, insurance guidelines, and TPA norms.
• Handle queries, discrepancies, and rejections raised by insurance companies/TPAs.

Billing & Financial Coordination

• Coordinate with the billing/accounts team for correct tariff application as per insurance agreements.
• Monitor deductions, short payments, and initiate follow-up for recovery where applicable.
• Assist in reconciliation of insurance payments and outstanding claims.

Communication & Follow-up

• Maintain regular communication with TPAs and insurance company representatives.
• Update patients on claim status and expected timelines.
• Escalate unresolved issues to the Insurance Manager or Hospital Administration.

Reporting

• Maintain daily and monthly reports on insurance admissions, approvals, rejections, and settlements.
• Submit periodic status reports to management as required.

Job Type: Full-time

Pay: ₹18,000.00 per month

Benefits:

• Flexible schedule
• Provident Fund

Work Location: In person