TPA Officer

TPA Officer

Location: Kalyan
Department: Billing / Insurance / TPA

We are seeking a detail-oriented and organized TPA Executive to manage all third-party insurance processes within the hospital. The role involves coordinating between patients, insurance companies, and internal departments to ensure timely and accurate processing of pre-authorizations, approvals, claims, and reimbursements.

Key Responsibilities:

TPA Coordination:

• Handle daily operations related to Third-Party Administrators (insurance companies, corporates, and government schemes).
• Ensure timely submission of pre-authorization requests and follow up on approvals.
• Act as the liaison between hospital departments and TPA
• Documentation & Records:
• Verify and maintain accurate records of patient insurance documents.
• Ensure completeness of documentation for claim submission.
• Prepare and submit final bills to TPAs for reimbursement.
• Claims Management:
• Monitor claim statuses and follow up on pending or rejected claims.
• Coordinate with finance/accounts for reconciliations and payment updates.
• Maintain a database of all claims submitted and their status.
• Patient Interaction:
• Guide insured patients regarding TPA formalities and requirements.
• Provide assistance during admission and discharge regarding insurance processing.
• Compliance & Reporting:
• Ensure compliance with all insurance policies and procedures.
• Generate periodic MIS reports and submit to management.

Qualifications:

· Graduate in any discipline

· 1–3 years of experience in hospital TPA operations or health insurance claims

· Knowledge of hospital billing software and TPA portals

Why Join Us:G Plus Heart Hospital & Vascular Intervention Center, located in Kalyan West, is a multi-super specialty hospital offering a range of cardiac and other specialized services. They focus on providing world-class cardiac care and have a dedicated cardiology department with experienced doctors. The hospital also offers neurosurgery, urological surgery, nephrology, oncological surgery, orthopedic surgery, and general and laparoscopic surgery.

9076206000 / [email protected]

Job Type: Full-time

Pay: ₹25,000.00 - ₹40,000.00 per month

Benefits:

• Cell phone reimbursement
• Health insurance
• Paid sick time
• Paid time off

Work Location: In person