Tpa Executive

18 hours ago

Delhi Delhi, India Mantra Care Full time

**Job Title**: TPA Executive/Empanelment Executive

**Location**: Eye Mantra Hospital
**Department**: Administration
**Reports to**: Operations Manager/Head of Insurance Relations

**Contact no. 9990906076**

**Job Summary**

The TPA (Third Party Administrator) Executive/Empanelment Executive is responsible for managing insurance-related processes, coordinating with TPAs and insurance companies for claims processing, and expanding the hospital’s network of empanelled insurers. The role requires effective communication, attention to detail, and strong organizational skills to ensure timely processing of claims and efficient operations.

**Key Responsibilities**:

- **TPA Management**:

- Handle pre-authorization requests and coordinate with TPAs for smooth claim processing.
- Ensure timely submission and follow-up of claim documents to TPAs and insurance companies.
- Maintain updated records of claims and ensure compliance with hospital policies and TPA agreements.
- Address and resolve queries from patients and TPAs related to insurance claims.
- Collaborate with the billing department to verify accurate documentation for claims submission.
- **Empanelment**:

- Liaise with various insurance companies and government health schemes to empanel Eye Mantra Hospital in their network.
- Prepare and submit empanelment proposals and manage all associated documentation.
- Monitor the renewal of empanelment contracts and ensure compliance with agreed terms.
- Establish and maintain good relationships with representatives from insurance companies and corporate clients.
- **Patient Assistance**:

- Assist patients in understanding their insurance benefits and coverage.
- Guide patients through the claim process, ensuring all necessary documents are in place.
- Address grievances or issues related to insurance and escalate them if necessary.
- **Reporting**:

- Provide regular reports on claims status, pending approvals, and settlements.
- Track and report any deviations or delays in claims processing to the management.
- **Compliance**:

- Ensure adherence to hospital policies, insurance regulations, and guidelines from regulatory bodies.

**Qualifications & Experience**:

- Bachelor’s degree in Healthcare Administration, Business Management, or related fields.
- Prior experience (2-4 years) in TPA operations, health insurance, or hospital empanelment is preferred.
- Knowledge of healthcare and insurance sector regulations and processes.
- Excellent communication and negotiation skills.
- Strong analytical skills and attention to detail.
- Proficiency in using hospital management systems and MS Office.

**Key Skills**:

- Strong interpersonal and customer service skills.
- Ability to work under pressure and meet deadlines.
- Problem-solving and decision-making capabilities.
- Good networking and relationship management skills.
- Familiarity with insurance claim processes and health schemes.

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

**Experience**:

- total work: 1 year (preferred)

Work Location: In person

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