Insurance Executive

A hospital insurance executive's roles include managing insurance-related tasks like verifying patient coverage, processing claims, and coordinating with insurance companies for pre-authorizations and settlements. Key responsibilities involve handling patient inquiries, ensuring accurate billing, maintaining records, and ensuring compliance with insurance policies and regulations. Core duties Insurance verification and coordination: Verify patient insurance coverage, limits, and eligibility to ensure a smooth process for both the patient and the hospital. Coordinate with patients, consultants, and insurance companies on pre-authorizations, approvals, and claim status. Claims processing: Process and manage claims from submission to settlement, handling both cashless and reimbursement cases. This includes preparing and submitting pre-authorization requests and discharge intimations. Patient and insurance company liaison: Act as a point of contact between patients, healthcare providers, and insurance companies to resolve issues and answer questions. Liaise with Third Party Administrators (TPAs) and corporate insurance departments. Record keeping and reporting: Maintain accurate records of all insurance transactions, documentation, and patient interactions. Generate and analyze reports on claim status, rejections, and other performance metrics for management. Policy and compliance Policy management: Ensure the hospital's insurance schemes are updated in the system and that all operations comply with current insurance policies, hospital guidelines, and healthcare regulations. Risk and compliance: Monitor insurance discounts and rejections to identify trends. Conduct audits of claims to ensure accuracy and implement corrective actions when necessary. Financial and billing responsibilities Accurate billing: Ensure accurate billing to insurance companies. Dispute resolution: Handle and resolve any issues or discrepancies related to claims processing. Strategic and administrative tasks Process improvement: Design, update, and implement policies and procedures to improve the efficiency and accuracy of insurance operations. Team support: Provide support and training to junior staff on best practices in claims processing and customer service. Job Types: Full-time, Permanent Pay: ₹16, ₹22,000.00 per month Benefits: Health insurance Paid sick time Provident Fund Work Location: In person

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