Insurance Executive

2 days ago

Puducherry, Puducherry, India GEM HOSPITAL Full time ₹ 1,60,000 - ₹ 2,20,000 per year

A hospital insurance executive's roles include managing insurance-related tasks like verifying patient coverage, processing claims, and coordinating with insurance companies for pre-authorizations and settlements. Key responsibilities involve handling patient inquiries, ensuring accurate billing, maintaining records, and ensuring compliance with insurance policies and regulations. Core duties

  • Insurance verification and coordination: Verify patient insurance coverage, limits, and eligibility to ensure a smooth process for both the patient and the hospital. Coordinate with patients, consultants, and insurance companies on pre-authorizations, approvals, and claim status.
  • Claims processing: Process and manage claims from submission to settlement, handling both cashless and reimbursement cases. This includes preparing and submitting pre-authorization requests and discharge intimations.
  • Patient and insurance company liaison: Act as a point of contact between patients, healthcare providers, and insurance companies to resolve issues and answer questions. Liaise with Third Party Administrators (TPAs) and corporate insurance departments.
  • Record keeping and reporting: Maintain accurate records of all insurance transactions, documentation, and patient interactions. Generate and analyze reports on claim status, rejections, and other performance metrics for management.

Policy and compliance

  • Policy management: Ensure the hospital's insurance schemes are updated in the system and that all operations comply with current insurance policies, hospital guidelines, and healthcare regulations.
  • Risk and compliance: Monitor insurance discounts and rejections to identify trends. Conduct audits of claims to ensure accuracy and implement corrective actions when necessary.

Financial and billing responsibilities

  • Accurate billing: Ensure accurate billing to insurance companies.
  • Dispute resolution: Handle and resolve any issues or discrepancies related to claims processing.

Strategic and administrative tasks

  • Process improvement: Design, update, and implement policies and procedures to improve the efficiency and accuracy of insurance operations.
  • Team support: Provide support and training to junior staff on best practices in claims processing and customer service.

Job Types: Full-time, Permanent

Pay: ₹16, ₹22,000.00 per month

Benefits:

  • Health insurance
  • Paid sick time
  • Provident Fund

Work Location: In person

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