Tpa Executive

2 days ago

CBD Belapur Navi Mumbai Maharashtra, India Acharya Shri Nanesh Hospital Full time

Job Summary: Manage TPA (Third Party Administrator) operations, ensuring efficient processing of health claims. Coordinate with healthcare providers, insurers, and customers to resolve claim-related issues. Analyze data to identify trends and areas for improvement in the claims process.

**Responsibilities**:

- Coordinate with healthcare providers, insurance companies, and patients to resolve claims-related issues.
- Process patient claims from admission to discharge, ensuring accurate and timely payment.
- Manage TPA (Third Party Administrator) activities, including claim settlements and reconciliations.
- Maintain CRM (Customer Relationship Management) software to track customer interactions and updates.
- Ensure compliance with regulatory requirements for medical insurance policies. Handling TPA related all process from billing to co-ordinate with TPA companies.
- Responsible for counselling patient's family & pre-Auth process.
- Maintaining & uploading patient's files on the portal.
- Couriering the hard copy of patient's medical file to the Insurance companies.
- Responsible for all co-ordination activities from patient's admission to discharge.
- Handling billing Department, Implants bill updating & reconciliation.
- Daily co-ordination with the patient and Hospital staff.
- Preparing split bills/ Doctor charges etc.
- Handling all TPA Portals.
- Outstanding follow-up with TPA.
- Monthly Review report.
- To obtain and review referrals and authorizations for treatments.
- To follow and adhere to all regulations and guidelines set by state programs, and HMO/PPO, etc.
- Must be aware of norms of the insurance sector.
- Daily follow up with Insurance companies to pass or clear the Health Insurance claims.

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

Pay: ₹27,127.64 - ₹30,681.51 per month

**Benefits**:

- Leave encashment
- Provident Fund

**Education**:

- Bachelor's (preferred)

Work Location: In person

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