Mediclaim /Insurance co ordinator

Job Title: Mediclaim Insurance Coordinator Department: TPA / Insurance Reports To: Manager Billing & Insurance / Hospital Administrator Job Summary The Mediclaim Insurance Coordinator is responsible for managing all health insurance and TPA (Third Party Administrator) processes, including cashless approvals, reimbursement claims, pre-authorizations, patient counseling, documentation, and coordination with insurance companies to ensure timely claim settlement and smooth patient discharge. Key Responsibilities Verify patient insurance eligibility and policy coverage. Coordinate with TPAs and insurance companies for cashless admission approvals. Process pre-authorization, enhancement requests, and final authorization. Collect, verify, and submit all required claim documents. Coordinate with doctors, nursing, medical records, billing, and accounts departments for claim-related documentation. Track pending approvals and follow up with insurers/TPAs for timely responses. Handle reimbursement claim documentation and guide patients on submission procedures. Resolve insurance queries, claim rejections, deductions, and deficiencies. Ensure accurate billing as per insurer and TPA guidelines. Maintain insurance records, approval trackers, and daily MIS reports. Coordinate discharge clearance after insurance approval. Educate patients and attendants regarding policy coverage, exclusions, and payment liabilities. Ensure compliance with hospital policies, IRDAI guidelines, and insurer requirements. Maintain confidentiality of patient information and insurance records. Required Qualifications Bachelor's degree in any discipline (B.Com, BBA, B.Sc., Hospital Administration preferred). Certification in Hospital Administration or Medical Insurance is an added advantage. Experience Fresher to 3 years of experience in hospital TPA/insurance coordination. Knowledge of cashless and reimbursement claim processes is preferred. Skills Required Knowledge of health insurance and TPA procedures. Medical terminology and hospital billing knowledge. Strong documentation and record-keeping skills. Excellent communication and patient counseling skills. Proficiency in MS Office and Hospital Information Systems (HIS). Good negotiation, coordination, and problem-solving abilities. Attention to detail and ability to work under pressure. Key Performance Indicators (KPIs) Timely processing of pre-authorizations and final claims. Reduction in claim rejections and deductions. Turnaround time (TAT) for insurance approvals. Accuracy of documentation. Patient satisfaction with insurance services. Timely discharge of insured patients. Compensation: 16,000.00 - 23,000.00 per month Work Location: In person .