TPA Executive

As a TPA (Third Party Administrator) Executive, you will be responsible for handling all insurance-related activities, including managing claims processing, coordinating with insurance companies, and ensuring the smooth functioning of TPA processes for patients. Your role will require excellent communication skills and attention to detail to ensure that patients receive timely assistance with their insurance claims. Key Responsibilities: - Claims Processing: - Handle and process insurance claims for patients, ensuring all required documentation is complete. - Review claim documents and verify the accuracy of information provided. - Submit pre-authorization requests and follow up on approvals from insurance companies. - Maintain accurate records of claims and approvals. - Coordination with Insurance Companies: - Act as the main point of contact between the hospital and TPA/insurance companies. - Ensure timely submission of claim documents and follow up on pending claims. - Resolve discrepancies and queries raised by TPAs/insurance companies. - Patient Support: - Assist patients in understanding their insurance coverage and provide guidance on the claims process. - Explain the process and requirements for cashless or reimbursement claims to patients and their families. - Coordinate with patients to obtain necessary documents for claim submission and ensure patient satisfaction through efficient handling. - Documentation & Record Keeping: - Maintain and update records of insurance claims, patient eligibility, and claim status. - Ensure compliance with documentation requirements for audit purposes. - Prepare and submit periodic reports on claim status, rejections, and pending approvals to management. - Liaison with Internal Departments: - Coordinate with the billing department for accurate invoicing and claim documentation. - Work closely with the finance and accounts team to ensure smooth claim settlements. - Collaborate with the medical team to gather necessary information for claim processing. This job is a full-time position with a day shift schedule. The work location is in person.,