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 promptly to claim queries and submit additional documents or clarifications within the stipulated time.
- Analyse deductions, short settlements and claim rejections and coordinate for reconsideration or appeal wherever justified.
- Reconcile claim amounts with payments received and coordinate with the Accounts Department for proper accounting and adjustment.
- Prepare insurer-wise and scheme-wise reports showing claims submitted, amounts approved, payments received, deductions, rejections and outstanding amounts.
- Ensure that insurance credit revenue matches the claims submitted to the respective insurance company, TPA or government scheme.
- Maintain proper records of agreements, package rates, tariff revisions, circulars and operating guidelines issued by insurers and government schemes.
- Ensure compliance with hospital policies, insurer requirements, government scheme guidelines and applicable statutory provisions.
- Maintain the confidentiality and security of patient, medical and insurance information.
- Attend meetings, audits and reconciliation discussions with insurance companies, TPAs, government authorities and hospital management.
- Escalate delayed approvals, high-value deductions, repeated queries and long-pending claims to the Insurance Manager or concerned authority.
- Provide courteous and timely assistance to patients and their relatives regarding insurance procedures and claim status.
- Perform any other insurance-related duties assigned by the management from time to time.

Pay: ₹11,000.00 - ₹15,000.00 per month

Work Location: In person

📌 Finance & Accounts Executive (Jamshedpur)
🏢 MHPL
📍 Jamshedpur