Insurance Executive

Insurance Executive (Hospital) Company: Andhra Prime Hospitals Location: Andhra Prime Hospitals, Guntur Department: TPA / Insurance Employment Type: Full-Time About Andhra Prime Hospitals Andhra Prime Hospitals is a NABH-accredited, fast-growing healthcare provider committed to delivering high-quality patient care and ensuring smooth, efficient hospital operations. We focus on clinical excellence, patient satisfaction, and streamlined administrative processes that support safe, ethical, and high-standard healthcare delivery. Role Description We are looking for a Hospital Insurance Executive to manage TPA and insurance operations, including cashless hospitalization, pre-authorizations, enhancement requests, reimbursement claims, documentation, and claim settlements. The candidate will coordinate closely with patients, doctors, nursing staff, billing, medical records, TPAs, and insurance companies to ensure timely processing and settlement of insurance cases. Key Responsibilities * Handle cashless hospitalization approvals from TPAs and insurance companies. * Verify patient insurance eligibility, policy coverage, exclusions, limits, and required documentation. * Prepare, submit, and follow up on pre-authorization requests. * Process and follow up on enhancement requests during hospitalization. * Coordinate with doctors, nursing staff, billing, and medical records departments for required documents. * Process cashless and reimbursement claim documentation. * Assist patients and attendants with insurance-related procedures and claim formalities. * Track pending approvals, queries, denials, and claim settlements. * Coordinate with TPAs and insurance companies to resolve queries and obtain timely approvals. * Follow up on pending claims and outstanding insurance receivables. * Coordinate with insurance companies for claim settlements and reconciliation. * Maintain accurate records of insurance cases, approvals, claims, and settlements. * Prepare and maintain MIS reports related to TPA and insurance operations. * Ensure compliance with NABH standards, hospital policies, TPA requirements, and applicable insurance guidelines. * Maintain confidentiality and accuracy of patient, medical, and financial information. * Escalate delays, discrepancies, or issues affecting patient discharge and claim settlement. Required Qualifications * Bachelors degree in any discipline. * Degree/Diploma in Healthcare Administration or Hospital Management is preferred. * Prior experience in hospital TPA/insurance operations, hospital billing, or healthcare claims is an advantage. * Proficiency in MS Office, particularly Word and Excel. Preferred Experience * Experience in a NABH-accredited hospital. * Knowledge of major TPAs and health insurance companies. * Experience handling cashless hospitalization and pre-authorization processes. * Knowledge of hospital billing and medical documentation. * Experience in insurance claim settlement and reconciliation. Skills Required * TPA & Health Insurance Operations * Cashless Authorization * Pre-Authorization & Enhancement * Claims Processing * Insurance Documentation * Hospital Billing Coordination * Strong Communication & Coordination * Follow-up & Problem Solving * MIS Reporting * Attention to Detail * MS Office Salary & Benefits Salary: Best in the industry, based on experience and qualifications. Opportunity to build a career in hospital insurance operations, revenue cycle management, and healthcare administration within a NABH-accredited hospital environment. Job Type Full-Time Location Andhra Prime Hospitals, Guntur .