Insurance Coordinator

Job description:

Job Summary

As ANC currently operates without direct insurance tie-ups, this role is twofold:

• Network Growth:You will actively visit and negotiate with TPA and Insurance companies to secure official empanelment (cashless tie-ups).
• Patient Support:You will manage the entire reimbursement documentation process for patients, ensuring they have everything required to successfully claim their medical expenses from their respective insurers post-discharge. If required applying for reimbursement on behalf of the patients

Key Responsibilities:

1. Empanelment & Networking (Primary Objective):

• Business Development:Actively visit TPA offices (e.g., Medi Assist, Heritage, Raksha) and Insurance companies to initiate the empanelment process.
• Documentation for Tie-ups:Prepare and submit the "Hospital Empanelment Form" along with required licenses
• Negotiation:Negotiate tariff rates and Service Level Agreements (SLAs) that are favorable to the hospitals revenue goals.

2. Reimbursement Management (Patient Support):

• Proactive Documentation:Since we are "Non-Cashless," you will take full ownership of the patients reimbursement file. This includes:
• Ensuring theDischarge Summaryis clinically detailed to prevent insurer queries.
• Compiling all original reports
• Correctly filling outPart-A and Part-Bof the insurance claim forms on behalf of the patient.
• Claim Counseling:Explain to patients exactly how the reimbursement process works, the expected timelines, and what "non-medical" expenses they should be aware of.

3. Knowledge & Compliance:

• Market Intelligence:Maintain an updated database of the reimbursement requirements for all major insurers (Star Health, Niva Bupa, HDFC Ergo, etc.) as processes vary between companies.
• Query Resolution:If a patients claim is contested, you will act as the hospital's representative to provide the necessary medical justifications to the insurance company.

Required Skills & Qualifications:

• Experience:35 years specifically inTPA EmpanelmentandInsurance Sales/Operationswithin the Hyderabad healthcare market.
• Connections:Existing relationships with TPA network managers in Hyderabad is a significant advantage.
• Communication:Exceptional persuasion skills. Must be fluent inTelugu and Englishto navigate both local patient needs and corporate insurance meetings.
• Technical Knowledge:Deep understanding of why claims get rejected and how to "bulletproof" a reimbursement file.

Performance Metrics (KPIs):

• Number of new TPA/Insurance tie-ups secured per quarter.
• Percentage of patient claims successfully settled (Reimbursement success rate).
• Reduction in patient grievances regarding insurance documentation.

Hope you have read the complete job description: If you have experience with processing Health Insurance reimbursements, Claims and Executing Agreements with TPA's and Insrances, whatsapp resume on 9030003460