A Senior Claims Coordinator is responsible for managing and coordinating the end-to-end claims process, ensuring that claims are accurately reviewed, properly documented, and resolved within defined timelines and company guidelines. The role involves coordinating with customers, insurers, service providers, internal teams, and other stakeholders to facilitate smooth claim settlements.

Key Responsibilities
  •    Handle day-to-day coordination with TPAs and insurance companies.
  •    Manage cashless admission and discharge processes.
  •    Submit pre-authorization requests and required medical documents within stipulated timelines.
  •    Follow up regularly on pending approvals and queries.
  •    Coordinate with insurance/TPA representatives for approval, enhancement, and final authorization.
  •    Ensure timely communication of approval status to patients and hospital departments.
  •    Resolve TPA-related issues and escalate complex cases to management when required.
  •    Verify patient insurance/TPA eligibility and policy details.
  •    Check required documents before submitting pre-authorization requests.
  •    Coordinate with doctors for medical information, diagnosis, treatment plans, and other required documents.
  •    Submit final bills, discharge summaries, investigation reports, prescriptions, and other required documents to TPAs.
  •    Ensure patients are properly informed about approved and non-approved amounts.
  •    Coordinate settlement of deductions and non-payable items.
  •    Ensure complete and accurate documentation for cashless and reimbursement claims.
  •    Coordinate closely with Billing, Doctors, Nursing, Medical Records, Pharmacy, Diagnostics, and Admission/Discharge departments.
  •    Keep patients informed regarding approval status, deductions, and pending requirements.