Job Description

:

1. Patient Admission & Pre-Authorization:

Coordinate and facilitate the admission of patients under cashless insurance schemes.

Collect and verify necessary documents required for pre-authorization.

Prepare and submit pre-auth requests to respective insurance companies or TPAS.

Ensure timely follow-up and approval to avoid delays in treatment.

2. Claim Documentation & Submission:

Maintain accurate records of all treatment, diagnostics, and procedural data required for claim submission.

Ensure that discharge summaries, invoices, investigation reports, and other required documentation are complete and in prescribed formats.

Submit claims to insurance providers or relevant authorities as per the guidelines of Private Insurance, GIPSA, CGHS & MJPJAY Scheme.

3. Payment Follow-up & Reconciliation:

Track and follow up with insurance providers/TPAs for claim status and payme updates.

Address queries or deficiencies raised by insurers and coordinate with interna departments for resolution.

Maintain updated records of receivables and prepare MIS reports on pending and cleared claims.

4. Compliance & Coordination:

Ensure compliance with statutory and regulatory requirements of all insurance and government schemes.

Liaise with internal departments (Front desk, clinical teams, billing) to streamline insurance workflows.

Keep abreast of updates and policy changes in insurance guidelines and schemes like MJPJAY, CGHS, etc.

Qualifications and Experience:

Graduate in any discipline (Commerce or Healthcare background preferred).

Minimum 2-3 years of experience in hospital insurance desk or related functions.

Knowledge of various health insurance schemes including Private Insurance, GIPSA, CGHS, and MJPJAY is essential.

Familiarity with

hospital billing

software and

TPA portals

is an advantage.

Skills Required:

Strong communication and interpersonal skills.

Attention to detail and excellent documentation practices.

Proficient in MS Office (especially Excel for report generation).

On hospital rolls, Interested candidates can send their CV to:

Jyoti.Prajapati@ssei.ind.in

Job Type: Full-time

Pay: From ?20,000.00 per month

Benefits:

Health insurance Leave encashment Life insurance Provident Fund
Work Location: In person