A TPA Executive is responsible for coordinating with insurance companies, patients, and hospital departments for smooth cashless and reimbursement claim processing.
Key Roles & Responsibilities
- Handle cashless hospitalization approvals and insurance claim processing.
- Coordinate with insurance companies and TPAs for patient authorization.
- Verify patient insurance documents, policy details, and eligibility.
- Maintain proper documentation for claim submissions and approvals.
- Prepare and submit pre-authorization and final bills to TPAs.
- Follow up on pending approvals, queries, and rejected claims.
- Ensure accurate billing as per insurance and hospital guidelines.
- Communicate with patients regarding insurance coverage and claim status.
- Coordinate with doctors, billing, and front office teams for required documents.
- Maintain records of approved, pending, and rejected claims.
- Resolve patient and insurance-related queries professionally.
- Ensure compliance with hospital policies and insurance procedures.
- Prepare daily and monthly MIS reports related to TPA operations.
- Monitor turnaround time (TAT) for approvals and claim settlements.
- Support patients during admission and discharge formalities related to insurance.
Pay: Up to ₹35,000.00 per month
Benefits:
Work Location: In person
