TPA Executive

• Job Summary: Manage TPA (Third Party Administrator) operations, ensuring efficient processing of health claims. Coordinate with healthcare providers, insurers, and customers to resolve claim-related issues. Analyze data to identify trends and areas for improvement in the claims process.

Responsibilities

• Coordinate with healthcare providers, insurance companies, and patients to resolve claims-related issues.

• Process patient claims from admission to discharge, ensuring accurate and timely payment.

• Manage TPA (Third Party Administrator) activities, including claim settlements and reconciliations.

• Maintain CRM (Customer Relationship Management) software to track customer interactions and updates.

• Ensure compliance with regulatory requirements for medical insurance policies. Handling TPA related all process from billing to co-ordinate with TPA companies.

• Responsible for counselling patient's family & pre-Auth process.

• Maintaining & uploading patient's files on the portal.

• Couriering the hard copy of patient's medical file to the Insurance companies.

• Responsible for all co-ordination activities from patient's admission to discharge.

• Handling billing Department, Implants bill updating & reconciliation.

• Daily co-ordination with the patient and Hospital staff.

• Preparing split bills/ Doctor charges etc.

• Handling all TPA Portals.

• Outstanding follow-up with TPA.

• Monthly Review report.

• To obtain and review referrals and authorizations for treatments.

• To follow and adhere to all regulations and guidelines set by state programs, and HMO/PPO, etc.

• Must be aware of norms of the insurance sector.

• Daily follow up with Insurance companies to pass or clear the Health Insurance claims.

Job Types: Full-time, Permanent, Fresher

Pay: ₹20,127.64 - ₹27,681.51 per month

Benefits:

• Leave encashment
• Provident Fund

Education:

• Bachelor's (Preferred)

Work Location: In person