Insurance Executive

2 weeks ago

Perungudi, Tamil Nadu, India Iswarya Health Pvt Ltd Full time ₹ 15,000 - ₹ 1,50,000 per year

The Insurance Coordinator is responsible for managing all activities related to patient insurance processing within the hospital. This includes handling pre-authorizations, insurance claims submission, approvals, follow-ups with TPAs/insurance companies, and ensuring timely reimbursements. The role is key to revenue cycle efficiency and patient satisfaction.

Key Responsibilities:

  • Pre-Authorization & Approvals
  • Obtain pre-authorizations from insurance companies/TPAs for surgeries, procedures, and admissions.
  • Ensure all necessary documentation (consultation notes, investigation reports, etc.) is attached with pre-auth requests.
  • Coordinate with medical and nursing staff to facilitate timely documentation.
  • Claims Processing
  • Prepare and submit insurance claims (cashless and reimbursement) in a timely and accurate manner.
  • Scrutinize medical bills and discharge summaries for completeness and correctness before submission.
  • Track claims status regularly and follow up with insurance/TPA teams for pending approvals.
  • Billing Coordination
  • Coordinate with billing and finance teams to ensure accurate mapping of insurance policies and packages.
  • Verify policy validity, coverage limits, exclusions, and co-payments.
  • Guide patients/families regarding their insurance eligibility and coverage.
  • TPA & Insurance Communication
  • Serve as the primary point of contact between the hospital and insurance/TPA representatives.
  • Maintain cordial and professional relationships with all external parties.
  • Resolve claim denials or discrepancies through negotiation and documentation support.
  • Documentation & Compliance
  • Ensure proper documentation of all communications, approvals, and claim-related records.
  • Maintain patient insurance files and databases with confidentiality.
  • Stay updated with changes in insurance guidelines, IRDA norms, and hospital policy.
  • Reporting
  • Generate periodic reports on claim status, TAT, pending amounts, rejected claims, and collection trends.
  • Escalate delays and bottlenecks to management as necessary

Working Conditions:

  • Full-time, based in the hospital premises
  • May involve shift duties (depending on hospital operations)
  • Interaction with patients, doctors, and third-party representatives
  • Teamwork and interdepartmental coordination
  • Ethical and transparent work practices
  • Problem-solving and analytical thinking

Job Types: Full-time, Permanent, Fresher

Pay: From ₹15,000.00 per month

Work Location: In person

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