Walk-in || Ayushman Bharat Portal & Claim Processing In-Charge

ob Summary

We are looking for an experienced Claim Processing & Ayushman Bharat Portal In-Charge to manage hospital insurance, TPA, and Ayushman Bharat (PM-JAY) claim-related activities. The candidate will be responsible for claim submission, pre-authorization, claim processing, query handling, rejection management, documentation, and regular follow-up with TPAs, insurance companies, and Ayushman Bharat authorities.

Key Responsibilities

• Manage day-to-day Ayushman Bharat / PM-JAY portal activities.
• Verify patient eligibility and scheme-related details.
• Handle pre-authorization and claim submission processes.
• Prepare, verify, and submit insurance/TPA/Ayushman claims within defined timelines.
• Ensure all required medical and billing documents are complete before claim submission.
• Monitor claim status regularly and maintain a claim tracking system.
• Follow up on pending, queried, rejected, approved, and settled claims.
• Review and respond to insurance/TPA/Ayushman queries within the required timeline.
• Coordinate with doctors, nursing, billing, medical records, pharmacy, laboratory, and other departments for claim documentation.
• Identify reasons for claim rejection and take corrective action.
• Maintain proper records of all submitted and settled claims.
• Prepare daily, weekly, and monthly reports related to claim submission and settlement.
• Track outstanding claim amounts and coordinate for timely settlement.
• Escalate critical and long-pending claims to hospital management.
• Ensure compliance with applicable insurance, TPA, and PM-JAY guidelines.

Required Skills

• Strong knowledge of Ayushman Bharat / PM-JAY claim processing.
• Experience in Hospital Insurance / TPA / Medical Billing / Claim Processing.
• Knowledge of pre-authorization and final claim submission.
• Good understanding of medical and billing documentation.
• Ability to handle insurance/TPA queries and rejected claims.
• Good knowledge of MS Excel and computer applications.
• Good communication, coordination, and follow-up skills.
• Ability to work independently and manage multiple claims simultaneously.

Qualification

• Graduate in any discipline.
• Candidates with a background in Hospital Administration, Healthcare Management, Medical Billing, Insurance, or related fields will be preferred.

Experience

25 years of relevant experience in hospital insurance, TPA, Ayushman Bharat/PM-JAY, or medical claim processing.

Key Performance Indicators (KPI)

• Timely submission of claims
• Claim approval and settlement rate
• Reduction in claim rejection rate
• Timely resolution of queries
• Reduction in pending claims
• Accuracy and completeness of claim documentation
• Timely follow-up for outstanding claim amounts

Preferred Candidate

Candidates currently working in Hospitals, Insurance/TPA Departments, Ayushman Bharat/PM-JAY Claim Processing, Medical Billing, or Healthcare Revenue Cycle Management will be preferred.