TPA Coordinator

Job Summary :- We are seeking a dedicated and experienced TPA Coordinator to join our healthcare team. The ideal candidate should have hands-on experience in managing cashless and reimbursement processes under various government and private health insurance schemes including Mediclaim, Swasthya Sathi, West Bengal Health Scheme (WBHS), and Central Government Health Scheme (CGHS).

Key Responsibilities :-

• Claims Processing & Documentation

1. Handle pre-authorization, admission, and discharge intimation for insured patients.

2. Prepare and submit all necessary documents for claims under Mediclaim, Swasthya Sathi, WBHS, and CGHS schemes.

3. Coordinate with TPA/Insurance companies for approval and claim settlement.

• Patient & Internal Coordination

1. Guide patients and their families regarding claim procedures, eligibility, and documentation.

2. Liaise with doctors, billing departments, and internal teams to ensure accurate documentation and timely processing.

3. Ensure correct entry and maintenance of data in hospital management systems.

• Scheme-Specific Handling

1. Maintain updated knowledge of rules and claim processes for Swasthya Sathi, WBHS, CGHS, and private Mediclaim policies.

2. Handle empanelment and renewals for different schemes, if required.

3. Ensure compliance with scheme-specific billing codes, package rates, and SOPs.

• Reporting & Auditing

1. Maintain claim registers and generate periodic MIS reports.

2. Follow up for pending approvals and payments with TPAs or scheme authorities.

3. Assist in audits and ensure adherence to compliance standards.

Job Types: Full-time, Permanent

Pay: ₹20,000.00 per month

Benefits:

• Health insurance
• Provident Fund

Education:

• Bachelor's (Preferred)

Experience:

• TPA Executive: 3 years (Required)

Work Location: In person