Third-Party Administrator

managing healthcare insurance claims by coordinating between patients, hospitals, and insurance companies, verifying coverage, and processing claims for cashless or reimbursement settlement

• Claim processing:

  Manage the end-to-end processing of healthcare insurance claims, including inpatient and outpatient services, as outlined in policy terms.

• Pre-authorization:

  Obtain pre-authorizations for cashless claims by submitting the required forms and medical information to the TPA or insurance company and following up on approvals.

• Documentation and verification:

  Review and validate claim documents and bills for accuracy and compliance, ensuring all necessary details are correct before submitting them to the insurer.

• Patient and provider liaison:

  Serve as the primary point of contact between patients, hospital staff, insurance companies, and other TPAs to facilitate the claims process and address queries.

• Billing and settlement:

  Prepare and manage the billing process, including pre-authorization, split bills, and post-discharge settlements, and follow up on outstanding payments with TPAs.

• Compliance and knowledge:

  Stay updated on healthcare policies, insurance regulations, and the specific norms of different insurance companies and government health schemes.

Required skills and qualifications

• Education:

  A bachelor's degree in healthcare administration, insurance, or a related field is often required.

• Experience:

  Prior experience in a TPA or healthcare insurance role is beneficial.

• Technical skills:

  Proficiency in Microsoft Office Suite and claims management software is necessary, along with familiarity with TPA portals.

• Soft skills:

  Excellent communication, problem-solving, and interpersonal skills are crucial. Strong attention to detail and the ability to work under pressure to meet deadlines (TAT) are also important.