TPA Executive

Job Description

Position: TPA Executive Location: Sunrise Hospital, Kalindi Colony Department: Billing & Insurance Reporting To: Billing/TPA Manager or Hospital Administrator Job Objective: To ensure smooth coordination and processing of TPA (Third Party Administrator) and insurance-related documentation for patient admissions, approvals, and discharges, ensuring proper billing and timely reimbursements. Key Responsibilities: TPA & Insurance Coordination: Handle pre-authorization requests and approvals from insurance companies and TPAs. Coordinate with patients, doctors, and TPA representatives for required documentation. Maintain accurate and updated records for all TPA/insurance patients. Billing Support: Ensure timely submission of medical bills to insurance companies. Cross-check the bills and ensure they comply with insurance norms and packages. Reconcile claims with approvals and ensure minimal deductions or rejections. Admission & Discharge Support: Facilitate the admission and discharge processes for TPA/insured patients. Prepare final bills in coordination with billing and medical departments. Ensure timely communication with TPA coordinators for discharge approvals. Documentation & Follow-up: Maintain complete files with all supporting documents like ID, policy copy, pre-auth forms, discharge summary, etc. Track pending claims and follow up for timely settlements. Coordinate with internal departments to resolve billing queries or discrepancies. Customer Support: Address patient queries related to TPA/insurance processing. Provide assistance in filling forms and understanding policies. Reporting: Generate daily/monthly reports on TPA/insurance billing and settlement status. Escalate unresolved or high-pending cases to management. Key Skills Required: Knowledge of insurance procedures, TPA coordination Good communication and interpersonal skills Proficiency in MS Office & Hospital Information Systems (HIS) Attention to detail and documentation Time management and ability to work under pressure Qualification & Experience: Graduate in any stream (Commerce/Healthcare preferred) Minimum 1–3 years of experience in hospital TPA/insurance desk Job Types: Full-time, Permanent Pay: ₹15,000.00 - ₹35,000.00 per month Benefits: Cell phone reimbursement Paid sick time Provident Fund Schedule: Rotational shift Supplemental Pay: Commission pay Performance bonus Yearly bonus Work Location: In person Application Deadline: 16/06/2025