TPA Executive / Insurance Coordinator
Organization: Kalyanam Karoti
Location: Mathura, Uttar Pradesh
Department: Hospital Administration / TPA & Insurance
Job Type: Full-time
Experience: 1–3 years preferred
Qualification: Graduate in any discipline; healthcare/insurance-related qualification preferred
Job Summary
Kalyanam Karoti is looking for a responsible and detail-oriented TPA Executive / Insurance Coordinator to manage cashless and insurance-related patient services. The candidate will coordinate with patients, hospitals, insurance companies and Third-Party Administrators (TPAs) to ensure smooth and timely processing of pre-authorizations, claims and settlements.
The ideal candidate should have good knowledge of hospital billing, cashless procedures, insurance documentation and TPA claim processes.
Key Responsibilities
- Handle TPA and health insurance-related patient cases.
- Coordinate cashless admission and discharge procedures.
- Submit pre-authorization requests to TPAs and insurance companies.
- Follow up for approval, queries and final authorization.
- Verify patient insurance details and eligibility.
- Collect and check all required documents for cashless/insurance cases.
- Coordinate with the billing, medical, nursing and administration departments.
- Prepare and submit insurance/TPA claim documents within timelines.
- Follow up on pending claims, queries and re-submissions.
- Coordinate with TPAs regarding claim status and settlement.
- Ensure accurate documentation of patient insurance records.
- Check bills and supporting documents before claim submission.
- Communicate with patients and their attendants regarding insurance procedures and requirements.
- Resolve documentation-related issues and coordinate with concerned departments.
- Maintain records of approved, pending, rejected and settled claims.
- Track outstanding insurance/TPA payments and follow up regularly.
- Prepare daily/weekly/monthly TPA reports for management.
- Ensure confidentiality and proper handling of patient information.
- Maintain professional communication with insurance companies and TPA representatives.
Required Skills
- Good knowledge of TPA and health insurance processes.
- Understanding of cashless hospitalization procedures.
- Knowledge of hospital billing and documentation.
- Good communication and interpersonal skills.
- Strong follow-up and coordination abilities.
- Good MS Office and computer skills.
- Ability to maintain accurate records.
- Attention to detail and accuracy.
- Ability to work under pressure and meet deadlines.
- Professional and patient-friendly approach.
Preferred Experience
Candidates with experience in:
- Hospital TPA Department
- Health Insurance Claims
- Cashless Authorization
- Hospital Billing
- Insurance Desk
- Claim Processing
- Medical Insurance Coordination
will be preferred.
Experience with TPA portals and insurance company portals will be an added advantage.
Educational Qualification
Essential: Graduate in any discipline from a recognized institution.
Preferred: Experience in hospital administration, healthcare management, insurance, TPA operations or medical billing.
Salary
Depending on qualification, experience and skills.
Key Performance Areas (KPI)
- Timely submission of pre-authorization requests
- Cashless approval turnaround time
- Timely claim submission
- Reduction in claim rejections
- Follow-up of pending claims
- Accuracy of insurance documentation
- Timely resolution of TPA queries
- Claim settlement and outstanding follow-up
- Patient and department coordination
Candidate Profile
The ideal candidate should be well-organized, responsible, patient-friendly and good at follow-up and coordination. The candidate must be able to work closely with hospital departments, patients, insurance companies and TPAs to ensure smooth processing of cashless and insurance cases.
Interested candidates can apply through Indeed with their updated CV. Candidates with prior hospital TPA/insurance experience will be given preference.
Pay: ₹8,086.00 - ₹36,413.41 per month
Work Location: In person
