Key Responsibilities

1. Insurance &

- TPA Coordination

- Coordinate with TPAs (Third Party Administrators) and insurance companies for claim processing.

- Handle cashless approvals, pre-authorizations, and claim submissions.

- Follow up for approvals, queries, and claim settlements.

2. CGHS Process Management

- Manage CGHS patient documentation, eligibility verification, and approval process.

- Ensure compliance with CGHS guidelines and package rates.

- Prepare and submit CGHS bills and supporting documents.

3. Billing &

- Documentation

- Prepare accurate insurance and CGHS bills as per hospital policies.

- Maintain proper documentation for claims, approvals, and rejections.

- Handle discrepancies and resubmissions.

4.

Patient

Coordination

- Guide patients and attendants regarding insurance and CGHS procedures.

- Explain billing, approvals, and required documents clearly.





5.

Claims

Follow-up &

- Reconciliation

- Track pending claims and ensure timely settlement.

- Reconcile payments received from insurance/CGHS.

- Maintain reports on pending, approved, and rejected claims.

6. Compliance &

- Audit

- Ensure adherence to hospital policies, insurance norms, and CGHS regulations.

- Support internal and external audits.

- Maintain confidentiality of patient and financial data.

Qualifications &

- Experience

- Graduate in any discipline (commerce/healthcare management preferred).

- 2-4 years of experience in hospital insurance/TPA/CGHS processing preferred.

- Knowledge of medical billing and insurance procedures.

📌 Walkin - Insurance CGHS Process -(2-3 years Hospital Experience) (Chennai)
🏢 Dr.Kamakshi Memorial Hospital
📍 Chennai