TPA COORDINATOR

Job Title: TPA Coordinator

Department: Claims / Health Insurance / HR / Administration (depending on the organization)
Reports To: Manager – Claims / Administration / HR
Location: REWARI
Job Type: Full-Time

Job Summary:

The TPA Coordinator is responsible for managing and coordinating all aspects of third-party administrator (TPA) interactions, including health insurance claims, reimbursements, empanelment of hospitals, and policy administration. The role ensures smooth communication between the organization, TPA, and employees or clients, facilitating efficient healthcare or insurance services.

Key Responsibilities:

• Serve as the primary point of contact between the organization and the TPA.
• Coordinate and monitor claim submissions, approvals, and settlements.
• Handle policy enrollments, endorsements, renewals, and cancellations with the TPA.
• Facilitate empanelment and communication with hospitals, clinics, or service providers.
• Address and resolve claim-related issues or disputes with TPA or service providers.
• Assist employees/customers with health insurance queries, documentation, and claim processes.
• Maintain up-to-date records of claims, policies, and communications.
• Ensure timely and accurate data entry in internal and TPA systems.
• Generate and share regular reports on claims status, TAT (Turnaround Time), and other KPIs.
• Ensure compliance with company policies, IRDAI (Insurance Regulatory and Development Authority of India) norms, and other regulatory guidelines.
• Conduct periodic audits or reviews of TPA performance and recommend improvements.

Required Qualifications and Skills:

• Bachelor’s degree in healthcare, business administration, insurance, or a related field.
• 2–5 years of experience in a similar TPA coordination or insurance claims role.
• Good knowledge of health insurance policies, claim processes, and IRDAI regulations.
• Excellent communication and interpersonal skills.
• Strong organizational and multitasking abilities.
• Proficiency in MS Office (Excel, Word, PowerPoint).
• Ability to handle sensitive information with confidentiality and integrity.

Preferred Qualifications:

• Prior experience working with insurance companies or TPAs.
• Familiarity with hospital billing and coding processes.

Job Type: Full-time

Pay: ₹10,000.00 - ₹30,000.00 per month

Benefits:

• Health insurance

Schedule:

• Day shift

Supplemental Pay:

• Overtime pay

Work Location: In person