Insurance Coordinator

JOB DESCRIPTION – INSURANCE COORDINATOR

Department: Insurance / Billing
Industry: Multispecialty Hospital
Reports To: Insurance Manager / Billing Manager

1. Job Purpose

To coordinate health insurance and cashless treatment processes, ensuring timely pre-authorizations, claim submissions, documentation, and settlement in accordance with hospital policies and insurance/TPA requirements.

2. Key Responsibilities

• Coordinate with insurance companies and Third-Party Administrators (TPAs) for cashless treatment approvals.
• Verify patient insurance eligibility, policy details, and coverage limits.
• Obtain pre-authorization and enhancement approvals for inpatient treatments.
• Ensure accurate preparation and timely submission of insurance claims.
• Coordinate with doctors, nursing staff, billing, medical records, and patients for required documents.
• Follow up on pending claims, queries, deductions, and rejected claims.
• Maintain insurance records, approval letters, claim status, and settlement details.
• Explain insurance procedures and documentation requirements to patients and their attendants.
• Support discharge coordination and ensure timely submission of final bills.
• Prepare daily and monthly reports on approvals, pending claims, rejections, and settlements.
• Maintain patient confidentiality and comply with hospital policies and applicable regulations.

3. Qualifications and Experience

• Graduate in any discipline; healthcare administration or insurance-related qualifications preferred.
• 1–3 years of experience in hospital insurance, billing, or TPA coordination preferred.
• Knowledge of cashless insurance procedures, claim documentation, and hospital billing processes.

4. Key Performance Indicators (KPIs)KPITargetTimely pre-authorization processing≥ 95%Claims submitted within the agreed timeline≥ 95%Documentation accuracy≥ 98%Timely follow-up on pending claims100% as per scheduleAvoidable claim rejection rateMinimizePatient and internal department satisfaction≥ 4/55. Required Competencies

• Knowledge of health insurance policies and TPA procedures.
• Strong communication and coordination skills.
• Accuracy in documentation and data entry.
• Follow-up, problem-solving, and time-management skills.
• Proficiency in MS Office and hospital information systems (HIS).
• Ability to work under pressure and meet deadlines.

6. Reporting and Accountability

The Insurance Coordinator reports to the Insurance Manager or Billing Manager and coordinates with insurance companies, TPAs, doctors, nursing staff, billing, medical records, and hospital administration.

7. Performance Evaluation

Performance will be assessed based on authorization turnaround time, claim submission accuracy, pending claim follow-up, rejection rates, documentation quality, and patient service.

Pay: ₹15,000.00 - ₹20,000.00 per month

Benefits:

• Cell phone reimbursement
• Flexible schedule
• Provident Fund

Work Location: In person