Job Description

Claims Management:

Manage end-to-end claims (cashless & reimbursement), tracking submissions, approvals, rejections, and ensuring timely settlement.

Liaison & Relationships:

Build strong ties with Third-Party Administrators (TPAs), insurance companies, and government schemes (like Ayushman Bharat, ESI).

Compliance & Documentation:

Ensure adherence to healthcare laws, hospital policies, and accurate medical coding (ICD/procedure codes) for claims.

Team Leadership:

Recruit, train, mentor, and manage the insurance team, setting performance targets and ensuring adherence to standards.

Process Improvement:

Analyze KPIs (DSO, denial rates), resolve disputes, and develop strategies to enhance efficiency, patient satisfaction, and revenue.

Patient & Staff Support:

Educate patients on coverage, support clinical staff, and handle escalated patient queries.

Reporting:

Prepare MIS reports, analyze data, and present performance insights to management.
Job Type: Full-time

Work Location: In person