Tpa Executive

**1. Educational Qualifications**
- Bachelor’s degree in **business administration, Healthcare Management, Insurance, Finance, or related field**:

- BBA or postgraduate diploma in Healthcare Management / Insurance preferred

**2. Work Experience**
- Minimum 2**-3 years**’ experience in hospital TPA management, health insurance, or claims processing
- Experience handling **TPA coordination, claim settlements, and insurance approvals** in a hospital environment
- Knowledge of **insurance policies, claim procedures, and regulatory guidelines**

**3. Core Skills & Knowledge**
- Managing and coordinating with TPAs for smooth claims processing
- Understanding of **insurance policy terms, claim documentation, pre-authorization,** and discharge approvals
- Monitoring and follow-up of **claim rejections, disputes, and escalations**:

- Preparing reports on claim status, approvals, denials, and financial reconciliation

**4. Technical Skills**
- Familiarity with Hospital Information Systems (HIS) and TPA portals
- Proficiency in MS Excel for data analysis and reporting

**5. Communication & Negotiation Skills**
- Strong verbal and written communication skills for interaction with insurance companies, hospital departments, and patients
- Negotiation skills to resolve claim disputes and expedite approvals

**6. Compliance & Documentation**
- Ensuring timely and accurate submission of documents as per insurance and hospital policies
- Maintaining audit-ready claim files and records
- Knowledge of healthcare regulations and insurance compliance requirements

**7. Performance Indicators**
- Claim settlement turnaround time
- Reduction in claim rejection rates
- Accuracy and completeness of claim documentation

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

Pay: ₹15,000.00 - ₹25,000.00 per month

**Benefits**:

- Leave encashment
- Paid sick time
- Paid time off
- Provident Fund

**Education**:

- Diploma (preferred)

**Experience**:

- Hospital TPA: 2 years (preferred)

Work Location: In person