- Bachelor’s Degree in Any Discipline (B.Com / BBA / B.Sc / BA)
- Basic knowledge of hospital billing and insurance processes preferred
Experience
- 1–2 years of experience in hospital insurance / TPA process preferred
- With valuable communication skills .
Job Summary The Insurance Executive is responsible for handling insurance and TPA processes, coordinating with insurance companies, ensuring proper documentation, and facilitating cashless and reimbursement claims in accordance with hospital policies and **National Accreditation Board for Hospitals & Healthcare Providers standards. Roles & Responsibilities1. Insurance & TPA Coordination
- Coordinate with insurance companies and Third Party Administrators (TPA) for patient claims.
- Verify patient insurance eligibility and policy details.
2. Cashless Processing
- Initiate cashless authorization requests with insurance companies.
- Follow up with TPA/insurance providers for approval and queries.
3. Documentation
- Collect and verify all required documents for insurance claims.
- Maintain proper records of insurance approvals, claims, and patient files.
4. Billing Coordination
- Coordinate with billing department and doctors for treatment details.
- Ensure accurate documentation for insurance billing and claim submission.
5. Patient & Attender Communication
- Explain insurance procedures, approvals, and claim processes to patients and relatives.
- Provide guidance regarding cashless and reimbursement policies.
6. Claim Follow-up
- Track pending claims and follow up with insurance companies or TPAs.
- Ensure timely submission and settlement of claims.
7. Compliance
- Follow hospital policies and **National Accreditation Board for Hospitals & Healthcare Providers guidelines.
- Maintain confidentiality of patient information and insurance documents.
Key Skills
- Communication and coordination skills
- Basic computer knowledge (MS Office / Hospital Software)
- Documentation and record management
- Problem-solving ability
- Customer service skills
Working Conditions
- Regular hospital working hours
- Interaction with patients, insurance companies, and hospital departments
Additional Responsibilities
- Assist in insurance audits and reports.
- Support hospital billing and patient service departments when required.