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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