Tpa Incharge and Executive

2 days ago

Navi Mumbai Maharashtra, India MPCT Hospital, Sanpada Full time

**Responsibilities**:

- **Claims Processing**: Oversee the processing of insurance claims for medical services provided by the hospital, ensuring timely and accurate submission.
- **Coordination**: Act as the primary point of contact between the hospital, insurance providers, and patients regarding claims and coverage issues.
- **Verification**: Verify insurance details, eligibility, and coverage limits before services are provided to patients.
- **Approval Management**: Handle pre-authorization and claim approvals with insurance companies.
- **Team Supervision**: Manage and guide the TPA team to ensure effective claims management and issue resolution.
- **Compliance**: Ensure that all claims comply with hospital policies and insurance regulations, maintaining accurate records.
- **Customer Support**: Assist patients with claims-related inquiries, addressing issues such as denied claims or coverage concerns.
- **Reporting**: Generate and submit regular reports to management regarding claim status, settlements, and outstanding issues.
- **Problem Resolution**: Address and resolve escalated claims issues, disputes, and billing discrepancies between patients, the hospital, and insurance providers.
- **Audit and Quality Assurance**: Ensure that the claims process follows the hospital’s internal guidelines and audit requirements.

For TPA Incharge:

- BHMS / BAMS
For TPA Executive:

- Graduate with have Minimum 4 years of Experience

Pay: ₹30,000.00 - ₹60,000.00 per month

**Benefits**:

- Health insurance

Schedule:

- Day shift

Supplemental Pay:

- Yearly bonus

Ability to commute/relocate:

- Navi Mumbai, Maharashtra: Reliably commute or planning to relocate before starting work (required)

**Experience**:

- total work: 5 years (required)

Work Location: In person

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