Job Description

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: ?16,000.00 - ?22,000.00 per month

Benefits:

Health insurance Paid sick time Provident Fund
Work Location: In person