Insurance Executive

2 days ago

Gandhipuram Coimbatore Tamil Nadu, India Ashwini Hospital Full time ₹ 3,60,000 - ₹ 6,00,000 per year

Insurance Coordination & Verification

  • Verify patient insurance eligibility, coverage, and policy terms before admission or procedures.
  • Ensure accurate documentation from patients for insurance processing.
  • Coordinate with consultants and departments to prepare required documents for authorization.

2. Pre-Authorization & Approvals

  • Initiate and obtain pre-authorization from insurance companies/TPAs for planned and emergency procedures.
  • Track and maintain records of all approvals, queries, and status updates.
  • Follow up promptly on pending or delayed authorizations.

3. Claims Processing & Submission

  • Prepare and submit insurance claims with complete and accurate documentation.
  • Review bills, case sheets, discharge summaries, and investigation reports for correctness.
  • Ensure claims are submitted within the stipulated time frame.

4. TPA / Insurance Company Coordination

  • Liaise with TPA representatives and insurance officers for approvals, queries, and claim clarifications.
  • Maintain professional relationships to ensure seamless coordination.
  • Attend audits and provide required case documents promptly.

5. Discharge & Billing Support

  • Coordinate with billing and medical records teams to ensure proper coding and documentation.
  • Provide insurance estimates to patients and update them regarding insurance deductions, exclusions, and coverage.
  • Assist in final bill settlement for insured patients.

6. Claim Follow-up & Reconciliation

  • Track claim status, resubmissions, and payment follow-ups.
  • Handle claim rejections/denials, rectify discrepancies, and coordinate for reprocessing.
  • Prepare monthly reconciliation reports on claims submitted, approved, rejected, and pending.

7. Compliance & Documentation

  • Ensure all insurance processes comply with hospital policies, IRDAI norms, and TPA guidelines.
  • Maintain secure and organized documentation for audits and verification purposes.
  • Update management on changes in insurance policies, tariffs, and TPA requirements.

Job Type: Full-time

Pay: ₹20, ₹30,000.00 per month

Benefits:

  • Health insurance
  • Leave encashment
  • Paid sick time
  • Provident Fund

Education:

  • Bachelor's (Preferred)

Experience:

  • Insurance department (Hospital): 5 years (Preferred)

Language:

  • Tamil. English (Preferred)

Work Location: In person

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