Tpa Executive

2 weeks ago

Dhantoli Nagpur Maharashtra, India Shankara Superspeciality Hospital Full time

Handle and process insurance claims, ensuring that all required documents are submitted and verified.
- Coordinate with hospitals to gather patient records, bills, discharge summaries, and other medical documents.
- Maintain accurate and up-to-date records of claims, including approval and rejection status.
- Communicate with insurance companies to verify policy coverage, pre-authorization, and claims approval.
- Facilitate smooth processing of claims by liaising between insurance providers and the hospital’s billing department.
- Follow up with insurers for claim approvals, payments, or rejections.
- Address patient queries related to insurance coverage, claim status, and documentation requirements.
- Provide assistance to patients in filling out claim forms and submitting necessary documents.
- Guide patients through the cashless claim process, ensuring mínimal hassle during their treatment.
- Handle pre-authorization requests from the hospital for treatments, surgeries, or procedures requiring insurance approval.
- Ensure timely submission of all necessary medical reports and documents to the TPA for approval.
- Work closely with the hospital's discharge team to ensure that insurance claims are processed before the patient is discharged.
- Coordinate final billing with the finance department to avoid delays in discharge due to pending claim approvals.
- Prepare detailed reports on claim status, patient insurance coverage, and payment settlements.
- Ensure that all claims are filed in compliance with the insurance company’s policies and regulatory requirements.
- Coordinate with doctors for medical opinions, required documents, and reports for claim submission.
- Communicate effectively with healthcare providers to ensure that all relevant medical details are accurately reflected in the claim.
- Ensure adherence to legal and regulatory requirements related to health insurance claims.
- Assist in audits and investigations related to insurance claims or billing discrepancies.

Pay: ₹10,000.00 - ₹15,000.00 per month

**Experience**:

- total work: 3 years (required)

Work Location: In person

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