Key Responsibilities

- Handle end-to-end cashless insurance processes, including patient eligibility verification, policy checks, pre-authorization requests, approvals, and discharge formalities.

- Process reimbursement claims and guide patients regarding required documents, claim submission procedures, and follow-ups.

- Coordinate with insurance companies and Third-Party Administrators (TPAs) for claim approvals, queries, settlements, and pending cases.

- Prepare, verify, and submit pre-authorization forms, medical reports, investigation reports, bills, discharge summaries, and other supporting documents.

- Track pre-authorization validity, approval limits, co-payment, deductibles, exclusions, and non-payable items.

- Explain insurance coverage, co-payment, deductions, and out-of-pocket expenses to patients and their families.

- Follow up on pending approvals, queries, rejected claims, and outstanding reimbursement or settlement cases.

- Coordinate with doctors, billing, reception, accounts, and medical records teams to ensure timely submission of accurate documents.

- Maintain insurance records, claim trackers, approval details, and daily reports.

- Assist with claim reconciliation, deficiency resolution, and documentation required for final settlement.

- Ensure compliance with clinic policies, insurer requirements, and patient confidentiality standards.

Required Skills





- Knowledge of cashless hospitalization and reimbursement procedures.

- Understanding of health insurance policies, TPAs, pre-authorization, and claim settlement.

- Good communication and patient-handling skills.

- Ability to explain insurance terms, co-payment, exclusions, and deductions clearly.

- Strong follow-up, coordination, documentation, and problem-solving skills.

- Basic computer knowledge, MS Excel, email, and data entry skills.

Qualifications and Experience

- Graduate in any discipline; healthcare, hospital administration, or insurance-related qualifications are preferred.

- Prior experience in hospital insurance coordination, healthcare billing, TPA operations, or health insurance claims is preferred.

- Freshers with a valuable understanding of insurance procedures and strong communication skills may also be considered.

Key Performance Indicators (KPIs)

- Timely submission of pre-authorization and reimbursement documentation.

- Turnaround time for cashless approvals and discharge clearances.

- Accuracy and completeness of claim documentation.

- Follow-up efficiency for pending claims and insurer queries.

- Reduction in claim rejections caused by documentation errors.

- Patient satisfaction and coordination effectiveness.

Pay: ₹22,000.00 - ₹27,000.00 per month

Benefits

- Provident Fund

Work Location: In person

📌 Insurance Co-ordinator (Pimpri-Chinchwad)
🏢 Healing Hands Clinic
📍 Pimpri-Chinchwad