Medical Insurance Manager
2 weeks ago
About Us
Continental Hospitals is India’s first LEED qualified super specialty hospital. With 800 beds and more than 60 specialties, the healthcare institution is a Joint Commission International (JCI) accredited Tertiary care facility, spread across 18 floors (1.3 million sq. ft). Continental Hospitals is built on international standards redefine healthcare in India by providing quality patient care with integrity, transparency, a collaborative approach, and evidence-based medicine.
We are looking for a highly skilled Medical Insurance Manager with an MBBS background to oversee the review and management of medical insurance claims and related queries. This role requires a professional who has a strong understanding of insurance processes, Third Party Administrators (TPA), and medical protocols. The ideal candidate should possess excellent communication skills, be able to explain complex medical information clearly to patients, and efficiently handle patient queries and claims-related issues.
Key Responsibilities:
- Claims Review & Management: Review medical insurance claims for accuracy, completeness, and adherence to insurance policies and guidelines.
- TPA Coordination: Collaborate with Third Party Administrators (TPAs) to ensure smooth claim processing and resolve any issues that may arise.
- Patient Communication: Counsel patients, explaining insurance coverage, claims processes, and addressing any queries or concerns they may have regarding their treatment and claims.
- Claims Dispute Resolution: Handle and resolve disputes related to claims, ensuring that both patients and insurance providers receive clear and timely communication.
- Documentation & Reporting: Maintain accurate records of claims, queries, and resolutions, and provide regular reports to management regarding claim status and issues.
- Collaboration: Work closely with healthcare providers, insurance companies, and internal teams to ensure efficient handling of all claims and related processes.
- Training & Guidance: Provide guidance to staff on insurance-related processes and patient interaction best practices.
Qualifications:
- Educational Qualification: MBBS (Bachelor of Medicine, Bachelor of Surgery) is a must.
- Experience:
- Minimum of 6 years of experience in medical insurance, claim management, or working with TPAs.
- Strong background in reviewing medical insurance claims and handling patient queries.
- Skills:
- Excellent communication and interpersonal skills to effectively communicate with patients and insurance providers.
- Strong understanding of insurance claims processes and the ability to explain them clearly to patients.
- Ability to work under pressure and manage multiple tasks effectively.
- Proficiency in medical terminology and knowledge of healthcare procedures.
Personal Attributes:
- Strong problem-solving skills and attention to detail.
- Empathetic and patient-focused approach to communication.
- Ability to handle sensitive information with discretion.
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Medical Insurance Manager
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hyderabad, India Continental Hospitals Full timeAbout Us Continental Hospitals is India’s first LEED qualified super specialty hospital. With 800 beds and more than 60 specialties, the healthcare institution is a Joint Commission International (JCI) accredited Tertiary care facility, spread across 18 floors (1.3 million sq. ft). Continental Hospitals is built on international standards redefine...
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