TPA Executive

• Manage the end-to-end processing of both cashless and reimbursement claims.
• Coordinate the pre-authorization process for planned treatments, surgeries, and hospital admissions by submitting necessary documents to the insurance company or TPA and following up for timely approvals.
• Guide and counsel patients and their families regarding their insurance coverage, eligibility, exclusions, required documentation, and the overall claim procedure.
• Meticulously review, verify, and upload all claim documents, including medical reports, bills, and discharge summaries, onto TPA portals to ensure accuracy and compliance with policy terms.
• Work closely with the hospital's billing department to prepare accurate bills, resolve discrepancies, track receivables, and reconcile accounts with various TPAs and insurance companies.
• Act as the primary point of contact for all TPA-related queries, resolve issues or rejections promptly, and perform daily follow-ups with insurance providers for claim status updates.
• Ensure all processes adhere to relevant regulations and guidelines set by authorities like IRDAI (Insurance Regulatory and Development Authority of India) and prepare management reports on claim statuses and turnaround times (TAT).

Job Type: Full-time

Benefits:

• Health insurance

Education:

• Bachelor's (Preferred)

Work Location: In person