Job Description

Key Responsibilities:

Receive and process

cashless hospitalization requests (pre-authorization forms)

from network hospitals.

Verify policy details

, coverage, and eligibility of insured members in the system.

Assess and evaluate

medical details provided by hospitals as per insurance policy terms, internal SOPs, and IRDA guidelines.

Coordinate with hospital authorities

to obtain required documents or clarifications. Liaise with

insurance companies or medical officers

for case approvals or escalations. Prepare and send

authorization letters

or denial letters within defined timelines.

Monitor and track ongoing hospitalization cases

, ensuring timely updates and approvals for enhancement requests. Maintain accurate documentation and update case status in the TPA system. Support the

claims team

in the final settlement process after patient discharge. Ensure compliance with

IRDA regulations

, TAT (Turnaround Time) standards, and organizational policies. Handle

customer queries

(patients, hospitals, or insurers) with professionalism and empathy.

Qualifications and Skills:

Education:

Graduate in any discipline

Experience:

1-3 years of experience in cashless operations, claims processing, or hospital billing (TPA/Health Insurance industry preferred).

Technical Skills:

Knowledge of health insurance processes and terminology. Familiarity with TPA software / hospital management systems. Proficiency in MS Office (Word, Excel, Email).

Soft Skills:

Strong communication and coordination skills. Good analytical and decision-making ability. Attention to detail and accuracy. Ability to work under pressure and meet tight deadlines. Customer service orientation.

Key Performance Indicators (KPIs):

Turnaround time (TAT) for pre-authorization and enhancement requests. Accuracy in processing cashless approvals/denials. Compliance with policy and IRDA guidelines. Customer (hospital/patient) satisfaction level. Reduction in case escalations or rework.
Job Types: Full-time, Permanent

Pay: ?20,000.00 - ?25,000.00 per month

Benefits:

Health insurance * Provident Fund