The Insurance Executive is responsible for managing all insurance-related operations within Sarji Vedaanth Hospital, ensuring smooth coordination between patients, insurance providers, and hospital departments. This role focuses on claim processing, authorization management, billing coordination, and ensuring compliance with insurance policies and regulatory requirements. The Insurance Executive plays a key role in enhancing the patient experience by ensuring timely approvals and accurate claim settlements.
Key ResponsibilitiesInsurance Coordination
Coordinate with various insurance companies and Third-Party Administrators (TPAs) for patient admissions, pre-authorization, and claim approvals.
Verify patient insurance eligibility, coverage limits, policy terms, and required documentation.
Pre-Authorization & Claims Management
Prepare and submit pre-authorization requests for planned and emergency procedures.
Monitor approval status and follow up promptly to avoid delays in patient care.
Manage end-to-end claims process including documentation, filing, tracking, and settlement.
Address claim queries and discrepancies from insurance providers.
Billing & Documentation
Work closely with the billing team to ensure accurate and complete documentation for claim submission.
Maintain updated patient files, medical records, and supporting documents required for audits.
Ensure coding accuracy (ICD, CPT, procedure codes) in coordination with the medical and billing teams.
Compliance & Quality Assurance
Ensure adherence to hospital policies, insurance guidelines, and regulatory requirements.
Stay updated on changes in insurance policies, TPA guidelines, and tariffs.
Support internal and external audits related to insurance and billing.
Patient & Stakeholder Communication
Educate patients and families about insurance coverage, exclusions, and financial responsibilities.
Provide timely updates to patients on authorization status and claim progress.
Build strong relationships with insurance representatives and TPAs.
Coordination with Internal Departments
Liaise with doctors, nursing staff, billing, and admission teams to ensure smooth workflow.
Escalate bottlenecks or operational challenges to management for timely resolution.
Job Types: Full-time, Fresher
Pay: ₹10,838.10 - ₹20,000.00 per month
Benefits:
Health insurance
Life insurance
Provident Fund
Ability to commute/relocate:
Chitradurga, Karnataka: Reliably commute or planning to relocate before starting work (Preferred)
Education: