Position Title: TPA Executive
Department: TPA / Insurance Billing
Reporting To: Adminstrator
Employment Type: Full-Time
Job Summary
The TPA Executive is responsible for coordinating with Third Party Administrators (TPAs), insurance companies, patients, and hospital departments for smooth processing of cashless and reimbursement claims. The role ensures timely approvals, accurate documentation, claim settlement, and patient satisfaction while maintaining compliance with hospital and insurance guidelines.
Key ResponsibilitiesInsurance & TPA Coordination
- Process cashless and reimbursement insurance claims.
- Coordinate with TPAs and insurance companies for pre-authorizations and approvals.
- Verify patient insurance eligibility, policy coverage, and documentation.
- Follow up on pending approvals, queries, and claim settlements.
- Maintain relationships with TPAs, insurance companies, and corporate panels.
Documentation & Claim Processing
- Prepare and submit pre-authorization requests and final claim documents.
- Ensure completeness and accuracy of medical records, bills, discharge summaries, and supporting documents.
- Maintain records of approved, pending, rejected, and settled claims.
- Update TPA portals and hospital information systems (HIS).
Patient Assistance
- Counsel patients regarding insurance coverage, exclusions, and claim procedures.
- Assist patients during admission and discharge formalities related to insurance claims.
- Address patient queries regarding approvals, deductions, and settlements.
Billing & Settlement
- Coordinate with billing and finance departments for claim settlement.
- Ensure insurance billing is prepared as per TPA and insurer requirements.
- Monitor claim turnaround time (TAT) and payment realization.
- Reconcile approved amounts and settlement records.
Compliance & Reporting
- Ensure compliance with hospital policies, insurance guidelines, CGHS/ECHS/ESIC requirements, and other government schemes.
- Prepare daily, weekly, and monthly MIS reports related to TPA operations.
- Support hospital empanelment activities with TPAs and insurance companies.
Qualification
- Graduate in any discipline (Hospital Administration/Healthcare Management preferred).
- Certification in Health Insurance or Hospital Administration will be an added advantage.
Experience
- 1–3 years of experience in TPA, insurance claims, hospital billing, or healthcare administration.
- Freshers with relevant training may also be considered.
Pay: ₹10,000.00 - ₹30,000.00 per month
Benefits:
- Cell phone reimbursement
- Paid sick time
- Paid time off
Work Location: In person
