Operation Executive

Job Description Operations Executive IDE
Job Title: Executive IDE (Insurance Desk Expert)
Experience: 0 to 1 Years
Salary Range: 1.8 to 2 LPA
Location: One of our reputed Partner hospitals in Hyderabad (Somjigda & Hitech city)
Department: Client Servicing KCSPL
Reports To: Supervisor / Assistant Manager Client Servicing

About Us
WeAssist, a services brand of Karthika Consulting & Solutions Private Limited, operates at the intersection of Insure-Tech, FinTech, and HealthTech. We build technology-driven platforms that simplify Reimbursement Claims, Cashless Claims, and healthcare insurance services, partnering with leading corporate hospital chains across India.
Over the past ten years, WeAssist has successfully managed thousands of healthcare reimbursement cases, delivering a seamless claims experience for patients, hospitals, insurers, and corporate partners. Backed by over three decades of insurance industry expertise through our parent company, Karthika Insurance, we combine deep domain knowledge with modern technology to build innovative digital healthcare solutions.

Job Summary
The Operations Executive IDE (Insurance Desk Expert) will be responsible for supporting the day-to-day operations of the Insurance Desk at partner hospitals.
The role involves patient interaction, claim documentation, hospital coordination, claim follow-up, grievance handling, and coordination with internal teams, TPAs, and insurance companies to ensure smooth and timely claim assistance.
The Executive will act as a point of contact for patients and hospital staff and ensure that all required information and documents are collected, verified, and shared with the relevant teams within the required timelines.
Key Job Duties & Responsibilities

1. Patient & Hospital Coordination

• Interact with patients and hospital staff regarding insurance and claim-related requirements.

• Understand patient queries and provide appropriate information regarding the claim process.

• Coordinate with hospital insurance desks, billing teams, and other relevant departments.

• Create and manage WhatsApp groups where required to facilitate communication and information sharing.

• Maintain professional and courteous communication with patients and hospital stakeholders.

2. Claim Documentation & Processing

• Collect necessary documents and information from patients and hospitals.

• Verify documents for completeness and accuracy before submitting them to the concerned team.

• Coordinate with the internal Medical, Claims Assistance, and Operations teams for claim processing.

• Share required documents and updates with the back-end team within defined timelines.

• Maintain proper records of claim-related documents and communication.

• Follow up on pending documents and information required for claim processing.

3. Cashless & Reimbursement Claim Assistance

• Support patients with cashless claim-related requirements.

• Create awareness among patients regarding reimbursement claims and the required process.

• Explain the basic claim procedure, documentation requirements, and applicable deductions to patients.

• Support patients with pre- and post-hospitalization reimbursement requirements.

• Coordinate with patients/hospitals to collect claim-supporting documents.

• Follow up with the relevant internal teams, TPAs, and insurance companies as required.

4. Claim Follow-Up & Updates

• Track the status of assigned claims and pending documentation.

• Follow up with the concerned teams for timely processing and closure.

• Provide regular updates to patients and hospital stakeholders.

• Ensure pending cases are followed up within the required timelines.

• Escalate delays or unresolved issues to the reporting manager/supervisor.

5. Grievance & Issue Handling

• Handle basic queries and grievances raised by patients and hospital staff.

• Understand the issue and coordinate with the appropriate internal team for resolution.

• Escalate complex or critical issues to the Supervisor / Assistant Manager.

• Maintain proper records of complaints and resolutions.

• Ensure timely communication and follow-up until the issue is resolved.

6. Data Entry & Reporting

• Maintain accurate claim and patient-related records in the designated systems.

• Update claim status and follow-up information regularly.

• Prepare basic daily/weekly reports as required.

• Maintain accurate documentation and MIS related to assigned activities.

• Ensure timely submission of required reports to the reporting manager.

7. Process Compliance & Quality

• Follow company SOPs, processes, and guidelines related to claim assistance.

• Ensure accuracy while collecting and submitting patient and claim documents.

• Cross-check information before sharing it with internal or external stakeholders.

• Maintain confidentiality of patient and insurance-related information.

• Adhere to defined turnaround times and service standards.

• Report process gaps, errors, or recurring issues to the reporting manager.

8. Cross-Functional Coordination

• Coordinate with Claims Assistance, Medical, Back Office, Finance, IT, HR, and other internal teams whenever required.

• Support the team in resolving claim, billing, documentation, and system-related issues.

• Maintain smooth communication between patients, hospitals, internal teams, TPAs, and insurance companies.

• Support additional operational activities assigned by the reporting manager.

Qualifications & Skills

• Any Diploma / Graduate / Undergraduate degree.

• 1 to 3 years of relevant experience in hospital operations, health insurance, claims processing, TPA operations, customer service, or healthcare operations.

• Prior experience in a hospital or insurance/TPA environment will be an added advantage.

• Good verbal and written communication skills.

• Good interpersonal and customer-handling skills.

• Basic analytical and problem-solving abilities.

• Basic knowledge of computers, MS Office, and digital communication platforms.

Required Competencies

• Good communication and interpersonal skills.

• Strong customer service orientation.

• Attention to detail.

• Good documentation and follow-up skills.

• Ability to multitask and prioritize activities.

• Strong ownership and accountability.

• Ability to work independently as well as part of a team.

• Good time management and organizational skills.

• Positive attitude and willingness to learn.

• Ability to work in a fast-paced hospital environment.

• Ability to handle sensitive and confidential information professionally.

Additional Skills

• Ability to interact confidently with patients and hospital staff.

• Strong follow-up and coordination skills.

• Ability to build positive working relationships with hospital stakeholders.

• Ability to handle patient queries professionally and patiently.

• Good problem-solving skills and willingness to take initiative.

• Ability to manage multiple claims and follow-ups simultaneously.

• Ability to work effectively with cross-functional teams.

• Willingness to learn insurance, claims, and healthcare processes.

• Ability to adapt to new technologies, systems, and processes.

• Strong work ethic and commitment to timely task completion.

• Ability to take ownership of assigned responsibilities and escalate issues appropriately.

• It is a Full Time Customer Support / TeleCaller job for candidates with 0 - 1 years of experience.