Duties
· TPA manager is responsible for managing and coordinating the activities related to third-party administrators (TPAs) and other insurance companies.
· For ensuring that all claims are processed in a timely and accurate manner.
· TPA manager will have excellent communication and interpersonal skills, as well as an in-depth knowledge of the insurance industry.
· Handling TPA related all process from billing to co-ordinate with TPA companies.
· Responsible for counseling patient's family & pre-Auth process.
· Maintaining & uploading patient's files on the portal.
· Couriering the hard copy of patient's medical file to the Insurance companies.
· Responsible for all co-ordination activities from patient's admission to discharge.
· Handling billing Department, Implants bill updating & reconciliation.
· Daily co-ordination with the patient and Hospital staff.
· Preparing split bills/ Doctor Charges etc.
· Handling all TPA Portals.
· Outstanding follow-up with TPA.
· Monthly Review report.
· To obtain and review referrals and authorizations for treatments.
· To follow and adhere to all regulations and guidelines set by state programs, and GIPSA COMPANIES.
· Must be aware of norms of the insurance sector.
· Daily follow up with Insurance companies to pass or clear the Health Insurance claims.
· TPAs take care of policy administration tasks and health card issuance.
· They also ensure that policyholders have all the required papers and information about their health insurance coverage.
· They are also in charge of conducting medical exams before the purchase of an insurance policy to underwrite the health insurance policy.
· TPAs handle health insurance claim processing. When a policyholder's medical expenses are reimbursed by their insurance policy, the TPA reviews the documents and talks with healthcare providers and policyholders to ensure a smooth settlement process.
· TPAs often have connections with a network of healthcare providers, including hospitals, clinics, and diagnostic facilities. These networks help policy holders’ access cashless healthcare services, streamlining the payment procedure and providing timely medical care.
· TPAs provide customer support to policyholders by answering questions, addressing problems, and providing information about policy benefits, claim status, and other related issues.
· They serve as a link between policyholders and insurance firms, enabling transparent communication.
· Policy-holders may need TPA’s pre-authorization before undertaking certain medical treatments or hospitalizations to ensure that the treatment is covered by the insurance policy.
Pay: ₹25,000.00 - ₹35,000.00 per month
Work Location: In person
