Insurance Executive
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**Job Title:** Insurance Executive
**Department:** Insurance / TPA Desk
**Location:** Krishnagiri l
**Reports To:** Finance Manager / Billing Manager
**Job Summary**
The Insurance Executive is responsible for managing all hospital insurance processes including patient eligibility verification, pre\-authorization, claim processing, and coordination with insurance companies/TPAs. The role ensures timely approvals, accurate documentation, and smooth claim settlement while maintaining patient satisfaction.
**Key Responsibilities1\. Insurance \& TPA Coordination**
* Coordinate with insurance companies and TPAs for **cashless approvals and claim processing** * Handle **pre\-authorization requests** and ensure timely approvals * Follow up on pending claims, queries, and settlements
**2\. Patient Insurance Handling**
* Verify patient **insurance eligibility and policy coverage** before admission * Explain insurance procedures, coverage, exclusions, and required documents to patients * Address patient and attendant queries regarding insurance claims
**3\. Documentation \& Claim Processing**
* Collect, verify, and submit all required documents for claims * Ensure accurate coding, billing, and documentation for claim approval * Maintain proper records of approvals, rejections, and settlements
**4\. Interdepartmental Coordination**
* Coordinate with doctors, nursing staff, billing, and MRD for claim\-related documents * Work closely with billing department to resolve discrepancies * Ensure smooth discharge process with insurance clearance
**5\. Follow\-up \& Reporting**
* Track pending claims and ensure timely closure * Prepare daily, weekly, and monthly MIS reports * Monitor Accounts Receivable (AR) related to insurance cases
**6\. Compliance \& Audit**
* Ensure compliance with hospital policies and insurance guidelines * Support internal and external audits * Maintain confidentiality of patient and insurance data
**Qualifications**
* Bachelor’s Degree (B.Com / BBA / Any Graduate) * Preferred: Hospital Administration / Healthcare Management
**Experience**
* 1–3 years (Freshers with knowledge can be considered) * Experience in **hospital insurance / TPA / billing** preferred
**Key Skills**
* Knowledge of **health insurance \& TPA processes** * Good communication and patient handling skills * Strong documentation \& coordination skills * Computer knowledge (MS Office \& HIS) * Problem\-solving and follow\-up skills
**Key Performance Indicators (KPIs)**
* Timely pre\-authorization approvals * Claim submission accuracy * Reduction in claim rejections * Faster claim settlement turnaround time * Patient satisfaction
**Salary Range (Indicative)**
* ₹10,000 – ₹15,000/month (based on experience)
Pay: ₹10,000\.00 \- ₹15,000\.00 per month
Benefits:
* Cell phone reimbursement * Paid time off * Provident Fund
Work Location: In person
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