TPA Incharge and Executive

As a Claims Processing professional in our hospital, your primary responsibility will be to oversee the timely and accurate submission of insurance claims for medical services provided by the hospital. You will serve as the main point of contact between the hospital, insurance providers, and patients, effectively managing claims and coverage issues. Prior to providing services to patients, you will be required to verify insurance details, eligibility, and coverage limits to ensure seamless processing. Handling pre-authorizations and claim approvals with insurance companies will also be a crucial part of your role. You will lead and supervise the Third Party Administrator (TPA) team to ensure efficient claims management and effective issue resolution. Maintaining compliance with hospital policies and insurance regulations, as well as accurate record-keeping, will be essential in your daily tasks. Furthermore, you will provide customer support by assisting patients with claims-related inquiries, resolving issues like denied claims or coverage concerns. Regular reporting to management on claim status, settlements, and outstanding issues will also be part of your responsibilities. Addressing and resolving escalated claims issues, disputes, and billing discrepancies between patients, the hospital, and insurance providers will require your problem-solving skills. You will be responsible for ensuring that the claims process adheres to the hospital's internal guidelines and audit requirements. For the role of TPA Incharge, candidates with BHMS/BAMS qualifications are preferred. For the TPA Executive position, a minimum of 4 years of experience is required. This is a full-time position with benefits including health insurance, yearly bonus, and day shift schedule. Candidates must have a total of 5 years of work experience and be willing to work in person at our location in Navi Mumbai, Maharashtra. Relocation before starting work is required for this role.,