A Sr. TPA (Third-Party Administrator) Executive manages health insurance claims, pre-authorizations, and billing between patients, hospitals, and insurance companies.
Key duties include verifying coverage, processing cashless/reimbursement claims, updating TPA portals, and ensuring timely claim settlements while providing customer service to patients.
Key Responsibilities
- Claim Processing: Handling cashless claim processes from admission to discharge, including preparing bills, updating implants, and reconciling accounts.
- Pre-Authorization: Obtaining and reviewing approvals for planned treatments and surgeries from insurance providers.
- Documentation & Portals: Maintaining accurate medical records, scanning documents, and managing TPA portals for updates.
- Coordination: Acting as the primary liaison between patients, hospital staff, and insurance companies for smooth service delivery.
- Patient Support: Advising patients on insurance benefits, coverage limits, and resolving queries regarding claims.
Required Skills and Qualifications
- Experience: 3 to 5 years of experience in healthcare, specifically TPA Dept.
- Education: Bachelor’s degree in any discipline.
- Knowledge: Strong understanding of insurance policies, TPA Process, guidelines, and medical terminology.
- Technical Skills: Proficiency in TPA portals and patient management.
- Communication: Excellent interpersonal skills to handle patient counseling and insurance coordination.
Job Types: Full-time, Permanent
Pay: ₹25,000.00 - ₹35,000.00 per month
Benefits:
- Paid sick time
- Paid time off
- Provident Fund
Ability to commute/relocate:
- Kalyan, Maharashtra: Reliably commute or planning to relocate before starting work (Required)
Experience:
- TPA AT HOSPITAL: 1 year (Required)
Work Location: In person
