Key Responsibilities of a TPA Coordinator
1. Insurance Verification
- Check patient insurance eligibility
- Verify policy details and coverage limits
2. Cashless Claim Processing
- Collect required documents from patients
- Submit pre-authorization requests to TPAs/insurance companies
- Coordinate approval for cashless treatment
3. Documentation Management
- Maintain patient insurance records
- Ensure all forms are correctly filled
- Upload and organize medical documents, bills, discharge summaries, etc.
4. Coordination Between Departments
- Communicate with:
- Doctors
- Billing department
- Insurance companies
- Patients and relatives
- Follow up on pending approvals and queries
5. Claim Settlement
- Assist in final bill settlement
- Resolve claim discrepancies or rejections
- Track claim status until completion
6. Patient Assistance
- Explain insurance procedures to patients
- Guide patients regarding:
- Required documents
- Coverage limits
- Approval timelines
7. Compliance and Reporting
- Follow hospital and insurance regulations
- Prepare daily/monthly reports of claims and approvals
Required SkillsTechnical Skills
- Knowledge of health insurance processes
- Medical billing understanding
- Documentation handling
- Computer proficiency (Excel, hospital software)
Soft Skills
- Communication skills
- Coordination ability
- Problem-solving
- Attention to detail
- Patience and customer handling
Educational Qualification
Typically:
- Graduate in any field
- Preferred:
- Hospital Administration
- Healthcare Management
- B.Com/BBA
Only apply Pune Candidate
Pay: ₹12,000.00 - ₹18,000.00 per month
Work Location: In person
