Assosiate Financial Operations

Key Responsibilities:

• Insurance Eligibility Check
• Understanding of Health Insurance terminologies Such as Sum insured, Balance Sum

insured , Room eligibility, Capping/Sublimit , Coverage , NME

• Explore corporate based insurance eligibility
• Pre-Auth Document Validation and Adjudication:
• Validate and adjudicate pre-authorization documents.
• Ensure all necessary documents are shared with the hospital and that pre-authorization

is raised and followed up on effectively.

• Approval and Communication:
• Update the internal tool once approval is received from the hospital.
• Provide financial counseling to patients as needed, in coordination with the CB

(Customer/Billing).

• Hospital Alignment:
• Ensure proper alignment with hospitals to avoid miscommunication.
• Confirm that the hospital conducts financial counseling, obtains patient consent, and

shares the signed copy with the MB Financial Operations team.

• Query Resolution:
• Ensure timely resolution of queries for all cases.
• Pre-Auth and Claim Rejections:
• Share a list of all pre-auth rejection cases with the IS TLs for cash and EMI counseling.
• For claim rejection cases, persuade patients to opt for cash (first preference) or EMI

options, and explain these options to both the CB and the patient, if required.

• Discharge Process
• Carefully review discharge documents before sharing them with the TPA to ensure room

eligibility, tariff accuracy, and genuine billing.

• Address TPA queries promptly and provide clear justifications to minimize repeated or

multiple queries.

• Ensure that hospitals collect out-of-pocket (OOP) payments as per the discharge

approval to avoid excess payments.

• Monitoring and Communication:
• Monitor WhatsApp groups and emails for any concerns raised by hospitals and the

Inside Sales Team.

• Assist Inside Sales in document collection and sharing, ensuring cases are properly

raised in Lead Square.

Basic Requirements:

Medical Background: Understanding of medical terminology and procedures.

Experience in Hospital Billing and Insurance: Familiarity with hospital billing processes

and insurance claims.

TPA Insurance SPOC: Experience as a single point of contact for TPA insurance

processes.

Preferred Qualifications:

• Strong communication and interpersonal skills.
• Ability to work collaboratively with hospitals, patients, and internal teams.
• Proficiency in using financial and healthcare management tools.
• Attention to detail and problem-solving skills.
• This JD outlines the responsibilities and qualifications for a Senior Associate role

focused on -pre-authorization and cashless processes in financial operations. Adjust the

details as needed to fit your organization's specific requirements.

• Seniority: Mid Level
• Languages: English