Job Details
Job Title: Third Party Administrator (TPA) Executive
Location: Paschim Vihar, Delhi
Experience: 2–5 years
Working Hours: 9:00 AM – 6:00 PM
Joining: Immediate joiners preferred
Employment Type: Full-time
Key Responsibilities
Manage cashless hospitalization and reimbursement claims from initiation to settlement.
Coordinate with TPAs, insurance companies, and CGHS authorities for pre-authorizations and claim approvals.
Verify patient insurance eligibility, policy coverage, exclusions, and required documentation.
Prepare and submit pre-authorization requests, claim forms, medical records, and supporting documents.
Follow up regularly on pending approvals, claim queries, settlements, and reimbursement cases.
Coordinate with doctors, nursing, billing, medical records, and front office teams to ensure timely and accurate documentation.
Ensure documentation and claim processing comply with TPA, CGHS, hospital, and NABH requirements.
Handle and resolve claim queries, discrepancies, deductions, and rejections within stipulated timelines.
Maintain accurate records of claims, approvals, settlements, pending cases, and follow-ups.
Assist patients and their attendants in understanding insurance procedures and provide timely updates regarding claim status.
Ensure adherence to hospital policies, quality standards, and applicable insurance regulations.
Requirements
2–5 years of relevant experience in TPA operations, medical insurance claims, hospital billing, or healthcare insurance coordination.
Mandatory: Hands-on experience in cashless hospitalization and reimbursement claims.
Working knowledge of insurance claim processes, pre-authorizations, and TPA coordination.
Knowledge of CGHS claim processing will be an added advantage.
Familiarity with NABH documentation and quality standards preferred.
Proficiency in MS Office and Hospital Information Systems (HIS).
Strong communication, coordination, documentation, and follow-up skills.
Ability to work efficiently in a hospital environment and handle patient-related queries professionally.
Why Join Us?
Join a growing NABH Accredited Ayurvedic healthcare organization where you can contribute to delivering quality patient care while building your career in healthcare insurance and TPA operations.
Candidates with relevant hospital TPA/insurance experience and immediate availability are encouraged to apply.
Please share your updated resume on 9311244889
Pay: ₹10,000.00 - ₹38,000.00 per month
Work Location: In person
