Department: Health Insurance & TPA

Location: Hyderabad, Telangana (On-site)

Experience: 5 to 8 Years (Mandatory recent experience in Hyderabad hospitals)

Timings: 10am to 6pm

Job Purpose

We are seeking an experienced and result-oriented Insurance Specialist to manage end-to-end cashless, reimbursement, and empanelment operations for our healthcare facility and Day Care/ANC centers. The ideal candidate will bring deep operational expertise in handling Indian health insurance companies and TPAs, driving seamless pre-authorizations, resolving queries/discrepancies, providing patient financial counseling, and leading GIC/GIPSA PPN empanelments.

Key Responsibilities1. Cashless & Reimbursement Operations

- Lead the end-to-end submission, processing, and settlement of pre-authorization requests, initial approvals, enhancement approvals, and final discharge summaries for Reimbursement and Cashless claims.
- Prepare and audit standardized claim dossiers and templates required for fast reimbursement processing and cashless settlements for both inpatient (IPD) and outpatient/ANC procedures.
- Actively track and resolve query letters, deficiency notices, and technical rejections from TPAs and insurance underwriters within stipulated turnaround times (TAT).
- Maintain a proven track record of recovering complex, disputed, or delayed reimbursement and cashless claims for both the hospital and individual patients.

2. Patient Financial Counseling & Treatment Conversion

- Provide empathetic, clear, and structured financial counseling to patients and families regarding coverage, non-payable expenses, co-payments, and deductible breakdowns.
- Translate complex clinical treatment packages and insurance terms into simple, transparent language to build trust and increase patient conversion rates for recommended procedures.
- Guide patients through "Anywhere Cashless" protocols and standard reimbursement claim procedures to minimize out-of-pocket friction.

3.



Hospital & ANC Center Empanelment (GIC & GIPSA PPN)

- Supporting in empanelment application process for our ANC centers with the General Insurance Council (GIC) and major private health insurers.
- Lead application filing, documentation compiling, tariff negotiations, site audit preparations, and follow-ups to successfully register centers on the GIPSA Preferred Provider Network (PPN) list (Public Sector Undertaking insurers: Recent India Assurance, National Insurance, Oriental Insurance, and United India Insurance).
- Regularly monitor agreement renewals, rate revisions, and network status updates across all TPA platforms.

4. TPA Liaison & Revenue Management

- Build and maintain strong operational relationships with key Indian TPAs (e.g., Medi Assist, FHPL, MDIndia, Vidal Health, Heritage, Raksha) and direct standalone health insurers (Star Health, Care, HDFC ERGO, ICICI Lombard, Neva Bupa, etc.).
- Track daily, weekly, and monthly Insurance MIS reports covering pre-auth approval TAT, claim rejections, outstanding insurance AR receivables, and settlement timelines.

Candidate Profile & Qualifications

- Experience: 5 to 8 years of dedicated hands-on experience in the Indian Insurance & TPA department of a hospital in Hyderabad, Telangana.
- Indian Market Knowledge: Minimum 5 years of recent, continuous experience working directly with Indian Health Insurance carriers and TPAs.
- Process Mastery: Mastery over standard TPA claim templates, clinical query response formats, billing systems, and ROHINI / National Health Authority compliance standards.
- Communication Skills: Excellent verbal and written communication skills in Telugu, English, and Hindi (essential for local patient counseling and regional TPA coordination).
- Problem Solving: Strong negotiation skills for tariff discussions and complex claim dispute resolutions.

Pay: ₹45,000.00 - ₹55,000.00 per month

Experience:

- Indian Medical Claim (Cashless & Reimbursement) Processing: 5 years (Required)

Work Location: In person

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