Job Summary

The Insurance Executive is responsible for coordinating cashless insurance approvals, managing patient insurance documentation, processing claims, following up with TPAs and insurance companies, ensuring timely claim settlements, and maintaining compliance with hospital and insurance guidelines. The role aims to provide a smooth experience for insured patients while maximizing claim realization.

Key ResponsibilitiesPatient Insurance Coordination

- Verify patient insurance eligibility and policy coverage.
- Explain cashless admission procedures to patients and attenders.
- Collect all required insurance documents before admission.
- Coordinate with patients, consultants, and nursing staff for documentation.

Cashless Approval Process

- Submit pre-authorization requests to TPAs/insurance companies.
- Follow up for approval, enhancement, and discharge authorization.
- Communicate approval status to patients and departments.
- Ensure timely approvals to avoid discharge delays.

Claims Management

- Prepare complete claim files with all required documents.
- Verify discharge summary, investigation reports, bills, prescriptions, and consent forms.
- Submit final claims within the stipulated timeline.
- Track pending claims until settlement.

Documentation

- Maintain accurate insurance records.
- Ensure completeness of case sheets before submission.




- Update claim status in hospital software.
- Archive claim documents for audit purposes.

Coordination

- Coordinate with Billing, MRD, Nursing, Consultants, Pharmacy, Laboratory, and Finance.
- Respond to insurance company queries promptly.
- Arrange additional documents whenever required.

Follow-up & Reconciliation

- Monitor pending approvals and outstanding claims.
- Follow up for claim settlement.
- Resolve deductions and rejection issues.
- Assist Finance in payment reconciliation.

Compliance

- Follow IRDAI, TPA, and hospital policies.
- Maintain confidentiality of patient information.
- Ensure NABH documentation standards are followed.

Qualifications

- Bachelor's Degree (Any Discipline)
- Preference for B.Com, BBA, MBA (Hospital Management), or Healthcare Administration.

Experience

- 0–2 Years: Insurance Coordinator / Insurance Executive (Junior)
- 2–5 Years: Hospital Insurance Executive
- Experience in TPA and cashless insurance processing is preferred.

Pay: ₹20,000.00 - ₹25,000.00 per month

Advantages:

- Leave encashment
- Paid time off
- Provident Fund

Education:

- Bachelor's (Required)

Experience:

- Hospital: 5 years (Required)

Location:

- Salem, Tamil Nadu (Salem) (Required)

Work Location: In person

📌 Hospital Insurance Executive (India)
🏢 Salem Gopi Hospitals.Pvt.Ltd
📍 India