Tpa Executive

Job Specification: TPA Executive Hospital

Educational Qualifications

• Graduate in any discipline (B.Com / BBA / BA)

  Required

• Diploma or Certification in Medical Billing, Health Insurance, or Hospital Administration

  Preferred

Experience

• 1-3 years of experience in a hospital or healthcare setting in

  TPA

  ,

  insurance coordination

  , or

  billing

• Freshers with healthcare internships may be considered for junior roles

Key Responsibilities

Pre-Authorization & Admission Process

• Verify patient insurance coverage at the time of admission.
• Submit pre-authorization requests to TPA/insurance companies.
• Coordinate with the treating doctor for medical details required in the authorization.

Claim Documentation & Processing

• Prepare and submit final bills, discharge summaries, and other required documents for claim settlement.
• Ensure completeness and accuracy of all documentation submitted.
• Follow up with TPAs and insurance companies on claim status.

Patient Coordination

• Explain the insurance/cashless process to patients and caregivers.
• Provide support on policy coverage, exclusions, co-payments, and deductions.
• Assist patients in completing claim forms and required paperwork.

Discharge & Settlement Coordination

• Coordinate with billing and clinical departments to expedite the discharge process.
• Ensure timely approval of final authorization from TPAs before patient discharge.
• Inform patients of approved/disallowed amounts and facilitate balance payments if required.

Follow-Up & Record Management

• Maintain detailed records of claims, approvals, denials, and pending cases.
• Track claim payments and escalate unresolved claims or discrepancies.
• Assist in internal and external audits related to TPA cases.

Reporting & Communication

• Prepare regular reports on TPA performance, claim status, rejections, and payments.
• Communicate effectively with TPAs, insurance coordinators, and hospital departments.

Key Skills

Technical Skills

• Knowledge of TPA and health insurance claim processing
• Familiarity with hospital billing systems and TPA portals
• Proficiency in MS Office (especially Excel) & PPT
• Understanding of pre-authorization, claim submission, and denial management
• Hindi & English Typing
• Writing Skills

Soft Skills

• Excellent communication and interpersonal skills
• Strong documentation and organizational abilities
• Customer service mindset and patient empathy
• Ability to handle pressure and multitask

Regulatory Knowledge

• Awareness of IRDAI guidelines (or equivalent in your country)
• Understanding of healthcare compliance and patient confidentiality norms
• Knowledge of hospital policies related to insurance billing and claim timelines
  

Interested candidate please share your resume on

7055514524 hrhead@gsmedicalcollege.in, hr2@gsmedicalcollege.com

or Walk-in Tuesday to Friday 10:00 AM to 1:00 PM

GS Medical College & Hospital

Near Pilkhuwa Railway Station, Pilkhuwa, Hapur Uttar Pradesh