TPA Executive

Key ResponsibilitiesClaim & Pre-Authorization Management

Processing pre-authorization requests for cashless treatments.

Reviewing medical documents to ensure policy compliance.

Submitting final claim files to insurance companies timely.

Resolving claim queries or discrepancies raised by insurers. [1, 2, 3, 4]

Hospital Billing Coordination

Preparing accurate In-Patient Department (IPD) and Out-Patient Department (OPD) bills.

Verifying medical charges, doctor fees, pharmacy items, and implant costs.

Checking co-payment rules, room rent capping, and non-medical exclusions.

Reconciling outstanding payments from diverse TPA companies. [1, 2, 3, 4]

Patient Care & Communication

Counseling patients regarding their specific insurance coverage limits.

Assisting with hospital entry and discharge formalities smoothly.

Addressing patient queries regarding deduction or claim rejection reasons. [1, 2, 3, 4]

dministration & Portal Management

Operating diverse TPA portals to track real-time claim status.

Maintaining up-to-date knowledge of healthcare insurance norms and ICD codes.

Generating monthly review reports tracking settlement efficiency. [1, 2, 3]

Pay

₹12,000.00 - ₹22,000.00 per month

Work Location

In person