TPA/ Corporate Executive

• Explain cashless, insurance, and TPA procedures to patients and attendants.
• Collect and verify insurance cards, ID proofs, policy details, and coverage limits.
• Guide patients regarding exclusions, co-payments, and approvals.
• Prepare and submit pre-authorization requests to TPAs/insurance companies within stipulated timelines.
• Coordinate with doctors for treatment plans, diagnosis, and estimates.
• Follow up continuously for approval and enhancement requests.
• Ensure accurate and complete documentation including:
• Admission notes
• Treatment details
• Investigation reports
• Discharge summaries
• Coordinate with billing department for interim and final bills.
• Ensure bills are prepared as per approved packages and TPA agreements.
• Submit final claims within the prescribed timeline after discharge.
• Regularly follow up with TPAs/insurance companies for claim settlement.
• Resolve claim queries, deductions, and rejections.
• Maintain claim tracking MIS and settlement status.
• Coordinate with doctors, nursing staff, billing team, and front office.
• Act as a liaison between hospital and TPAs/insurance companies.
• Attend TPA audits and resolve discrepancies.
• Maintain daily MIS of admissions, approvals, discharges, and pending claims.
• Prepare monthly reports on claim status, TAT, and deductions.
• Update management on high-value or delayed claims.

Key Skills

• Knowledge of TPA, insurance, and cashless processes
• Understanding of hospital billing and medical terminology
• Strong follow-up and negotiation skills
• Good communication and patient-handling skills
• Proficiency in MS Excel, and email communication

Qualification & Experience

• Education: Graduate (any discipline); MBA/Healthcare Management preferred
• Experience: 1–3 years in hospital TPA/insurance operations
• Industry: Healthcare / Hospital

Salary is Negotiable for deserving Candidate

Job Type: Full-time

Pay: ₹15,000.00 - ₹22,000.00 per month

Benefits:

• Health insurance
• Provident Fund

Work Location: In person