INSURANCE EXECUTIVE

Daya General Hospital Ltd.; Thrissur; On-site; INR 240,000 - 420,000; Full time

Job summary

Daya General Hospital Ltd. in Thrissur, Kerala, is hiring an Insurance Executive to manage day-to-day insurance operations including pre-authorization, documentation, and claim submissions.

The role collaborates with doctors, TPAs, and hospital departments to ensure timely approvals and accurate billing. The candidate should possess a graduate degree and any medical insurance/billing certification; 0-2 years experience preferred.

Qualifications

• Graduate degree in any discipline, commerce or business administration preferred.
• Certification or training in Medical Insurance / Billing is an added advantage.
• Understanding of insurance workflows, pre-authorization, and claim processing.
• Familiarity with TPA portals, HIS/ERP billing systems, and insurance documentation.

Responsibilities

• Handle pre-authorization and collect clinical notes, treatment plans and estimates.
• Prepare and submit insurance bills per approved packages, tariffs and agreements.
• Maintain complete insurance documentation and claim records with accuracy.
• Follow up with TPAs for claim status, payments, and clarifications.
• Coordinate with admissions, billing, medical records, and accounts for smooth processing.
• Ensure compliance with NABH/JCI requirements and internal audits.

Skills

Insurance workflows

Pre-authorization

Claim processing

Communication with TPAs

Education

Graduate in any discipline (Commerce/Business Administration preferred)

Training or certification in Medical Insurance / Billing

Tools

HIS/ERP billing systems

Job description

1. Position Summary

The Insurance Executive is responsible for handling day-to-day insurance operations including pre-authorization, documentation, claim submission, follow-ups, and coordination with TPAs, insurance companies, and internal departments. The role ensures timely approvals, accurate billing, proper documentation, and efficient claim processing to support patient care and hospital revenue realization.

Job Duties

1. Pre-Authorization Patient Support

• Collect and verify patient insurance documents and policy details.
• Prepare and submit pre-authorization requests for cashless admissions and procedures.
• Coordinate with doctors for clinical notes, treatment plans, and estimates.
• Inform patients and bystanders about approvals, co-payments, exclusions, and timelines.

2. Insurance Billing Claim Processing

• Prepare insurance bills as per approved packages, tariffs, and agreements.
• Compile complete insurance claim files including admission notes, investigations, prescriptions, and discharge summaries.
• Submit final claims to TPAs/insurance companies within stipulated timelines.
• Maintain accurate claim submission records and trackers.

3. Documentation Record Maintenance

• Ensure completeness and accuracy of insurance documentation.
• Maintain physical and digital insurance files, registers, and claim logs.
• Ensure confidentiality of patient and insurance data.

4. Claim Follow-up Query Handling

• Follow up with TPAs/insurance companies for claim status and payments.
• Handle claim queries, shortfalls, and requests for additional information.
• Coordinate resubmissions and clarifications with clinical and billing teams.

5. Coordination Communication

• Coordinate with admissions, billing, medical records, pharmacy, diagnostics, and accounts for seamless insurance processing.
• Support PRO/front office teams for patient counselling on insurance procedures.
• Escalate complex cases or delays to Insurance In-Charge or Deputy Manager.

6. Reporting MIS

• Update daily trackers for pre-authorizations, claims submitted, approvals, and settlements.
• Assist in preparing MIS reports on pending claims, aging, and recoveries.

7. Compliance Quality Standards

• Follow hospital SOPs, payer agreements, and NABH/JCI requirements.
• Support audits and inspections by providing accurate records and reports.

8. Continuous Learning

• Stay updated on insurance policy changes, package revisions, and regulatory guidelines.
• Participate in internal training and process improvement initiatives.

9. Sustainability Environmental Responsibility

Promote paper-less and digital processes to reduce paper consumption and administrative waste.

Use office equipment, electricity, and water responsibly and follow energy-saving practices.

Support sustainable procurement by minimizing unnecessary purchases and encouraging reusable or low-impact supplies where applicable.

Maintain accurate sustainability-related documentation required for NABH, JCI, and internal audits.

Participate in environmental sustainability awareness and training programs.

Encourage a culture of environmental responsibility and compliance within administrative functions.

Educational Qualification

• Graduate in any discipline (Commerce/Business Administration preferred).
• Training or certification in Medical Insurance / Billing is an added advantage.

Experience

• 0-2 years of experience in hospital insurance/TPA operations.
• Experience handling cashless insurance cases preferred.

Skills Competencies

Technical Process Knowledge

• Understanding of insurance workflows, pre-authorization, and claim processing.
• Familiarity with TPA portals, HIS/ERP billing systems, and insurance documentation.

Accuracy Attention to Detail

• High level of accuracy in billing and document preparation.

Communication Coordination

• Effective communication with TPAs, insurers, patients, and hospital teams.

Follow-up Time Management

• Strong follow-up skills to ensure timely approvals and settlements.

Professional Behaviour

• Ethical, confidential, patient-focused, and service-oriented.
• Ability to work under pressure and manage multiple cases simultaneously.