TPA Executive

Job Description

Key Responsibilities Claims Processing & Management: Process and manage healthcare insurance claims accurately and efficiently through government portals. Coordinate with TPAs for pre-authorization, cashless treatment approvals, and claims processing. Verify documents and ensure accurate and timely submission of claims. Track claim statuses and follow up on pending or rejected claims.DoctHub | Jobs+10Expertia+10Bajaj Allianz General Insurance Company+10Bajaj Allianz General Insurance Company+6Placement India+6Joblum+6 Portal Expertise: Navigate and operate government healthcare portals such as RGHS, CGHS, and Chiranjeevi for claim submissions and status tracking. Stay updated with any changes or updates on these portals to ensure compliance and efficiency. Query Resolution: Address and resolve queries related to claims, eligibility, and policy coverage. Liaise with government officials and TPA representatives to expedite claim processing and resolve discrepancies.DoctHub | Jobs Documentation & Reporting: Maintain accurate and up-to-date records of all claims, approvals, and communications. Prepare and submit regular reports on claim statuses, pending approvals, and resolved issues.Expertia+3Jupiter Hospital+3Placement India+3 Customer Coordination: Guide patients on eligibility and processes for government healthcare schemes. Ensure beneficiaries receive entitled treatment and services under schemes like PMJAY. Address grievances related to insurance and scheme benefits promptly Skills: Proficiency in navigating RGHS, CGHS, and Chiranjeevi portals. Strong understanding of health insurance policies, PMJAY guidelines, and claim processing. Excellent communication and negotiation skills. Proficiency in data management and healthcare software. Problem-solving and grievance-handling abilities. Knowledge of regulatory and compliance requirements Job Type: Full-time Pay: ₹15,000.00 - ₹25,000.00 per month Schedule: Fixed shift Work Location: In person