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 hospital’s revenue goals.

2. Reimbursement Management (Patient Support):

- Proactive Documentation:
Since we are "Non-Cashless," you will take full ownership of the patient’s reimbursement file. This includes:
- Ensuring the Discharge Summary is clinically detailed to prevent insurer queries.
- Compiling all original reports
- Correctly filling out Part-A and Part-B of 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 patient’s 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:

3–5 years specifically in TPA Empanelment and Insurance Sales/Operations within the Hyderabad healthcare market.
- Connections:
Existing relationships with TPA network managers in Hyderabad is a significant advantage.
- Communication:
Exceptional persuasion skills. Must be fluent in Telugu and English to 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