Job Description – TPA Executive (2:00 PM to 9:00 PM Shift)
Position: TPA Executive
Department: TPA/Insurance & Ayushman Desk
Shift Timing: 2:00 PM to 9:00 PM
Location: Sanjivini Super Speciality Hospital
Job Summary
The TPA Executive will be responsible for managing all TPA and insurance-related activities, including cashless hospitalization processes and Ayushman Bharat (PM-JAY) schemes. The role involves patient registration, documentation, obtaining approvals, claim processing, and coordination with insurance companies, TPAs, and hospital departments to ensure smooth patient services and timely claim settlements.
Key Responsibilities
- Handle cashless hospitalization cases and coordinate with TPAs and insurance companies for approvals and claim settlements.
- Verify insurance eligibility and process pre-authorization requests with all required documentation.
- Manage all activities related to Ayushman Bharat (PM-JAY), including beneficiary verification, patient registration, package selection, and claim submission.
- Ensure proper documentation and timely submission of Ayushman and TPA claims as per guidelines.
- Coordinate with doctors, nursing staff, billing, and front office teams to collect necessary medical records and treatment updates.
- Follow up on pending approvals, queries, and claim settlements from TPAs and Ayushman authorities.
- Explain insurance coverage, Ayushman benefits, package details, and claim procedures to patients and attendants.
- Maintain accurate records of cashless admissions, approvals, claims, rejections, and discharged cases.
- Prepare daily and monthly reports related to TPA and Ayushman cases.
- Ensure compliance with hospital policies, TPA guidelines, and Ayushman Bharat operational protocols.
- Assist in audits, inspections, and documentation requirements related to insurance and Ayushman schemes.
- Maintain confidentiality of patient information and all claim-related documents.
Required Qualifications
- Graduate in any discipline (Preference: Hospital Administration, Healthcare Management, or related field).
- Minimum 1–2 years of experience in Hospital TPA Operations and Ayushman Bharat (PM-JAY) processes.
- Sound knowledge of health insurance procedures, cashless hospitalization, claim processing, and Ayushman package management.
- Proficiency in MS Office and Hospital Information Systems (HIS).
Required Skills
- Excellent communication and coordination skills.
- Strong documentation and follow-up abilities.
- Knowledge of medical terminology and hospital workflows.
- Ability to work under pressure and meet deadlines.
- Problem-solving and patient-handling skills.
- Attention to detail and high level of professional ethics.
Compensation & Working Hours
- Shift Timing: 2:00 PM to 9:00 PM
- Working Days: As per hospital policy.
Pay: ₹10,000.00 - ₹15,000.00 per month
Work Location: In person
