TPA Executive

• Handle cashless hospitalization processes for all TPA & insurance patients
• Verify insurance eligibility, policy coverage, and pre-authorization requirements
• Prepare and submit pre-authorization requests within defined TAT
• Coordinate with doctors, nursing staff, and billing team for treatment details & estimates
• Follow up with TPAs/insurance companies for approval, enhancement, and clarifications
• Maintain accurate documentation including:
• Admission notes
• Treatment sheets
• Investigation reports
• Discharge summaries
• Prepare and submit final bills and claim documents within stipulated timelines
• Track claim status and ensure timely settlement
• Handle query management, deductions, and justifications raised by TPAs
• Maintain daily MIS reports of admissions, approvals, discharges, and pending claims
• Coordinate for rejections, short payments, and appeals
• Ensure compliance with IRDA, hospital policies, and TPA guidelines
• Provide patient counselling regarding insurance process, exclusions, and co-payment
• Maintain confidentiality of patient and financial data

Key Skills & Competencies

• Strong knowledge of TPA & Health Insurance processes
• Understanding of medical terminology and billing codes
• Excellent communication and coordination skills
• Ability to work under pressure and strict timelines
• Good documentation and follow-up skills
• Proficiency in HIS, MS Excel, and hospital billing software

Educational Qualification

• Graduate in any discipline (B.Com / BBA / BA preferred)
• Certification in Medical Billing / TPA Operations (added advantage)

Experience

• 5-7 years of experience as a TPA Executive / Insurance Coordinator in a hospital

Job Types: Full-time, Permanent

Pay: ₹20,000.00 - ₹35,000.00 per month

Experience:

• tpa: 4 years (Required)

Work Location: In person