Executive (Claim Operations)

Jobaaj Com; Bengaluru, Coimbatore District, Ahmedabad District; On-site; INR 300,000 - 480,000; Full time

Job summary

Jobaaj Com is seeking a Front-End Desk Counselor for patient counseling and admission guidance at the hospital. You will greet patients and families, explain insurance coverage, pre-authorization processes, and room rent caps, ensuring clear expectations and smooth admission documentation.

The role includes handling cashless claim processing, pre-authorization submissions, and coordination with hospital staff, TPAs, and insurers to minimize delays and disputes.

Qualifications

• 1-3 years in hospital TPA/insurance desk is required.
• Direct hands-on experience in hospital TPA/helpdesk is mandatory.
• Thorough knowledge of cashless workflows, reimbursement guidelines, ICD codes, and pre-authorization forms.

Responsibilities

• Front-end desk role: greet, counsel patients and families at admission.
• Explain health insurance coverage, co-pays, deductions, and room rent caps to prevent disputes.
• Assist with initial documentation, eligibility checks, and pre-authorization forms for TPAs.

Skills

Empathetic Counseling

Multilingual Communication

MS Office Proficiency

Tools

TPA Portal Management

Job description

Role & responsibilities

Patient Counseling & Admission Guidance (Front-End Desk)

Greet and counsel patients and their families upon admission regarding health insurance coverage, co-pay clauses, deductions, non-payable items, and overall timelines.

• Set clear expectations with patients regarding pre-authorization procedures, policy sub-limits, and room rent capping to prevent post-discharge disputes.
• Assist patients with initial documentation, verification of active insurance policies, and eligibility checks.
• Cashless Claim Processing & Pre-Authorization
• Prepare and submit complete pre-authorization forms to TPAs and Insurance Companies.
• Coordinate closely with hospital admission desks, nursing staff, and medical records teams to attach required initial clinical notes, diagnostic reports, and estimation letters.
• Follow up continuously with TPA/Insurance desks to secure timely Initial Pre-Auth Approvals and Enhancement Approvals during treatment.

Reimbursement Claim Processing

Guide and assist non-cashless patients with the complete reimbursement documentation workflow.
Collate, verify, and organize original itemized bills, discharge summaries, pharmacy vouchers, implants invoices, diagnostic reports, and payment receipts.
Prepare file submissions, dispatch claims to TPA/Insurers, and guide patients on tracking their reimbursement status.
TPA Helpdesk & Hospital Coordination
Manage day-to-day operations at the hospitals dedicated TPA / Health Insurance Helpdesk.

• Serve as the primary liaison between patients, hospital billing teams, clinical advisors, TPA desk staff, and insurance auditors
• Maintain active coordination with top TPA partners (e.g., Medi Assist, MDIndia, Heritage,
• Paramount, Vidal, etc.).
• Query Resolution & Settlement Tracking (Back-End Operations)
• Monitor and immediately address query letters or deficiency requests raised by TPAs/Insurers to prevent processing delays.
• Facilitate final bill processing, coordinate pre-discharge final authorization approval, and minimize patient waiting time during discharge
• Track claims through the post-discharge lifecycle to ensure final claim settlement, reconciliations, and closure.
• Maintain daily tracking logs of patient admissions, pre-auth status, queries, approvals, rejections, and pending settlements.

Preferred candidate profile

Experience Required: 1-3 Years (Minimum 8-12 months in Hospital TPA Cell / Insurance Desk mandatory)
Must-Have Experience: Direct hands-on experience working in a Hospital TPA Helpdesk, Hospital Insurance Cell, or TPA Company.
Domain Expertise: Thorough knowledge of cashless workflows, reimbursement guidelines, ICD codes, pre-authorization forms, medical terminology, and hospital billing documents.

• Soft Skills: Empathetic, calm demeanor with strong patient counseling and crisis negotiation skills.
• Communication: Clear verbal communication skills in English and regional languages (Hindi /
• Kannada / local state language).
• Technical Skills: Basic computer proficiency in Excel, MS Office, and online TPA portal management.