Job Title: TPA Executive
Department: Billing / Insurance / TPA
Reports To: Billing Manager / Operations Head
Job Summary:
The TPA Executive is responsible for managing all Third Party Administrator (TPA) and insurance-related processes in the hospital. This includes patient coordination, documentation, pre-authorization, claim processing, and ensuring smooth cashless and reimbursement services.
Key Responsibilities:
- Handle cashless hospitalization cases through various TPAs and insurance companies.
- Coordinate with patients, doctors, and insurance providers for pre-authorization approvals.
- Ensure proper documentation and verification of patient records and insurance details.
- Prepare and submit final bills and claim documents to TPAs/insurance companies.
- Follow up with TPAs for approval, query resolution, and claim settlement.
- Maintain accurate records of all TPA/insurance transactions.
- Guide patients and attendants regarding insurance policies, coverage, and procedures.
- Coordinate with internal departments (billing, nursing, doctors) for smooth claim processing.
- Handle rejection cases and work on re-submissions if required.
- Ensure compliance with hospital policies and NABH standards.
Job Type: Full-time
Pay: From ₹15,000.00 per month
Benefits:
Work Location: In person
