Job Description

Patient & Insurance Coordination

Explain insurance procedures, coverage, exclusions, and documentation requirements to patients and attendants. Verify patient insurance eligibility, policy details, and coverage limits at the time of admission. Assist patients in completing insurance forms and consent documents.
Cashless & Claim Processing

Prepare and submit

cashless pre-authorization requests

to TPAs/insurance companies. Follow up on approvals, denials, and enhancements in a timely manner. Coordinate with treating doctors, billing department, and nursing staff for required medical documents. Prepare and submit final claims with accurate bills, discharge summaries, investigation reports, and prescriptions.
Documentation & Compliance

Ensure completeness and accuracy of all insurance-related documents. Maintain proper records of submitted, approved, rejected, and pending claims. Ensure compliance with hospital policies, insurance guidelines, and TPA norms. Handle queries, discrepancies, and rejections raised by insurance companies/TPAs.
Billing & Financial Coordination

Coordinate with the billing/accounts team for correct tariff application as per insurance agreements. Monitor deductions, short payments, and initiate follow-up for recovery where applicable. Assist in reconciliation of insurance payments and outstanding claims.
Communication & Follow-up

Maintain regular communication with TPAs and insurance company representatives. Update patients on claim status and expected timelines. Escalate unresolved issues to the Insurance Manager or Hospital Administration.
Reporting

Maintain daily and monthly reports on insurance admissions, approvals, rejections, and settlements. Submit periodic status reports to management as required.
Job Type: Full-time

Pay: ₹18,000.00 per month

Benefits:

Flexible schedule Provident Fund
Work Location: In person