Insurance Officer

Wellvoyage Healthcare Solutions; Thiruvananthapuram; On-site; INR 420,000 - 600,000; Full time

Job summary

Wellvoyage Healthcare Solutions is seeking an experienced professional to manage the hospital insurance desk, assisting patients with cashless and reimbursement processes. The role includes verifying eligibility, coordinating with insurers/TPAs, and ensuring timely claim submissions.

The candidate should have a graduate degree and 2–8 years of relevant experience, with strong communication, documentation, and MS Office/HIS skills. Shifts may be rotational as required.

Qualifications

• Graduate in any discipline (Healthcare Administration, Nursing, Pharmacy, Life Sciences, or Commerce preferred).
• 2 to 8 years of experience in hospital insurance desk, TPA, insurer, or healthcare claims environment.

Responsibilities

• Manage hospital insurance desk and assist patients with cashless and reimbursement processes.
• Verify patient insurance eligibility, policy coverage, and pre-authorization requirements.
• Coordinate with insurers/TPAs for cashless approvals and pre-authorization submissions.
• Educate patients on policy coverage, exclusions, co-pays, deductibles, and claim procedures.
• Maintain records of all insurance cases and claim status.
• Coordinate with hospital billing to ensure timely submission of claims.

Skills

Communication skills

Interpersonal skills

Customer handling

Documentation

Attention to detail

Education

Graduate degree (any discipline)

Tools

MS Office

Hospital Information Systems (HIS)

Job description

Role & responsibilities:

• Manage the hospital insurance desk and assist patients with cashless and reimbursement insurance processes.
• Verify patient insurance eligibility, policy coverage, and pre-authorization requirements.
• Coordinate with insurance companies, TPAs, and insurance brokers for cashless approvals.
• Prepare and submit pre-authorization requests along with the required medical documents within stipulated timelines.
• Follow up regularly with insurers/TPAs to obtain timely approvals and resolve queries.
• Coordinate with treating doctors, nursing staff, billing department, medical records, and pharmacy for accurate documentation.
• Ensure all claim documents are complete, accurate, and submitted as per insurer/TPA guidelines.
• Facilitate admission, enhancement requests, discharge approvals, and final claim settlements.
• Educate patients and their attendants on policy coverage, exclusions, co-payments, deductibles, and claim procedures.
• Resolve insurance-related patient queries and provide a high level of customer service.
• Maintain proper records of all insurance cases, approvals, denials, pending claims, and claim status.
• Coordinate with the hospital billing department to ensure timely billing and claim submission.
• Track pending claims and follow up for settlement to minimize outstanding receivables.
• Ensure compliance with hospital policies, insurer guidelines, IRDAI regulations, and internal SOPs.
• Build and maintain professional relationships with insurance companies, TPAs, and hospital departments.
• Assist in achieving departmental turnaround time (TAT) and quality benchmarks.

Preferred candidate profile:

• Graduate in any discipline (Healthcare Administration, Nursing, Pharmacy, Life Sciences, or Commerce preferred).
• 2 to 8 years of experience in a hospital insurance desk, TPA, insurance company, or healthcare claims environment.
• Knowledge of cashless hospitalization, reimbursement claims, medical insurance documentation, and claim processing.
• Good communication, interpersonal, and customer handling skills.
• Proficiency in MS Office and Hospital Information Systems (HIS).
• Ability to work in rotational shifts if required.
• Strong attention to detail and documentation skills.