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Job Profile:

 | The Senior Insurance Reconciliation Officer is responsible for executing end-to-end reconciliation of insurance claims for Prime Healthcare Group. The role ensures timely reconciliation of rejected and any outstanding claims, coordination with insurance companies, TPAs, reducing rejection percentage and supports operational efficiency through accurate resubmissions and reporting. 

·        Execute timely reconciliation of insurance, TPA accounts across Prime Healthcare Group facilities.

·        Coordinate effectively with insurance companies and TPAs to reconcile rejected and outstanding claims.

·        Undertake claim resubmissions as per payer instructions to ensure closure of reconciliation accounts.

·        Ensure rejection percentage is within the yearly target set by the Manager / Management.

·        Reduce rejection percentage and analyze denial trends.

·        Prepare and submit weekly reconciliation summaries and reconciliation status reports to the Insurance Manager.

·        Liaise with branch teams to obtain required documentation for timely resubmissions.

·        Coordinate with IT teams for resolution of HIS system issues, errors, and XML / JSON file-related challenges.

·        Maintain reconciliation sign-off records.