Job Role :  Senior Mediclaim Executive is responsible for managing end-to-end health insurance (mediclaim) processes, including cashless and reimbursement claims, coordination with TPAs and insurance companies, ensuring compliance with policy guidelines, and supporting patients for smooth claim settlements. 

Key Responsibilities :

• Handle cashless and reimbursement mediclaim cases from admission to discharge
• Verify patient insurance eligibility, policy coverage, exclusions, and limits
• Coordinate with TPAs and insurance companies for pre-authorizations and approvals
• Prepare, check, and submit pre-authorization requests with complete documentation
• Follow up on pending approvals, queries, and claim settlements
• Ensure accuracy of billing, coding, and medical documents as per insurer norms
• Guide and support junior mediclaim executives and billing staff
• Handle escalations related to claim rejections, deductions, or delays
• Maintain proper records of claims, approvals, denials, and payments
• Ensure compliance with hospital policies, insurer guidelines, and regulatory standards
• Coordinate with doctors, nursing staff, and billing department for required medical details