Tpa Coordinator

5 days ago

Bhawanipur Kolkata West Bengal, India Reliable F M S Pvt. Ltd. Full time

**Key Responsibilities:

- **
- **Claims Processing & Documentation**

**1.**Handle pre-authorization, admission, and discharge intimation for insured patients.

**2.** Prepare and submit all necessary documents for claims under Mediclaim, Swasthya Sathi, WBHS, and CGHS schemes.

**3.** Coordinate with TPA/Insurance companies for approval and claim settlement.
- **Patient & Internal Coordination**

**1.** Guide patients and their families regarding claim procedures, eligibility, and documentation.

**2.** Liaise with doctors, billing departments, and internal teams to ensure accurate documentation and timely processing.

**3.** Ensure correct entry and maintenance of data in hospital management systems.
- **Scheme-Specific Handling**

**1.** Maintain updated knowledge of rules and claim processes for Swasthya Sathi, WBHS, CGHS, and private Mediclaim policies.

**2.**Handle empanelment and renewals for different schemes, if required.

**3.** Ensure compliance with scheme-specific billing codes, package rates, and SOPs.
- **Reporting & Auditing**

**1.** Maintain claim registers and generate periodic MIS reports.

**2.** Follow up for pending approvals and payments with TPAs or scheme authorities.

**3.** Assist in audits and ensure adherence to compliance standards.

**Job Types**: Full-time, Permanent

Pay: ₹20,000.00 per month

**Benefits**:

- Health insurance
- Provident Fund

**Education**:

- Bachelor's (preferred)

**Experience**:

- TPA Executive: 3 years (required)

Work Location: In person

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