Duties and Responsibilities - Insurance Executive (Hospital)
- Verify patients’ insurance eligibility, policy validity, coverage limits, waiting periods, exclusions, co-payment and other applicable conditions.
- Collect and verify all required documents, including insurance cards, identity proof, policy details, referral letters, investigation reports and medical records.
- Obtain pre-authorisation from insurance companies, TPAs and government health schemes before admission or treatment, wherever required.
- Prepare and submit pre-authorisation requests with accurate diagnosis, proposed treatment, estimated cost and supporting medical documents.
- Coordinate with doctors, nursing staff, billing, pharmacy, laboratory and other departments to obtain required clarifications and documents.
- Monitor pre-authorisation requests and promptly respond to queries raised by insurance companies or TPAs.
- Inform patients and their relatives about the approved amount, non-payable items, co-payment, deductions and expenses not covered under the policy.
- Verify that treatments, procedures,



medicines, consumables and investigations are within the approved package or authorisation.
- Obtain enhancement approval whenever the treatment cost is expected to exceed the initially approved amount.
- Review interim and final bills to ensure accuracy and compliance with approved tariff, package rates and insurance guidelines.
- Prepare and submit cashless and reimbursement claims within the prescribed timelines.
- Ensure that claim files contain all necessary documents, including discharge summary, final bill, prescriptions, investigation reports, implant stickers, utilisation details and patient acknowledgements.
- Follow up with insurance companies, TPAs and government authorities regarding pending approvals, claim processing and payments.
- Track submitted, pending, queried, approved, rejected and settled claims through an updated claim register or hospital information system.
- Respond

📌 Insurance Executive (Jamshedpur)
🏢 MHPL
📍 Jamshedpur