TPA Executive

LJ Eye Institute is looking for TPA Executive to join our dynamic team and embark on a rewarding career journey.
A TPA (Third Party Administrator) Executive's job description can vary based on the specific company or industry they work in. However, here's a generalized job description for a TPA Executive : Job Title : TPA ExecutiveJob Summary : As a TPA Executive, you will be responsible for managing and overseeing various aspects of third - party administration services for clients. Your primary goal will be to ensure the smooth and efficient processing of claims and other administrative functions while maintaining high levels of customer satisfaction. You will collaborate with internal teams and external stakeholders to deliver exceptional service and meet client expectations. Responsibilities : Claims Management : Handle and process insurance claims efficiently and accurately, adhering to the company's guidelines and relevant regulations. Client Communication : Serve as the main point of contact for clients, addressing inquiries, resolving issues, and providing updates on claim statuses. Policy Administration : Review and validate insurance policy details to ensure correct coverage and policy benefits for claim processing. Documentation and Record Keeping : Maintain accurate records of all claim - related documents, transactions, and communications. Coordination with Healthcare Providers : Liaise with hospitals, doctors, and other healthcare providers to facilitate the smooth processing of medical claims. Network Management : Collaborate with the network management team to maintain a strong network of healthcare providers and negotiate contracts with them. Quality Assurance : Implement and maintain quality assurance processes to ensure accurate and timely claim processing. Reporting : Prepare and present reports on claim processing metrics, performance, and client satisfaction.