Tpa Coordinator

4 days ago

Shahpura Bhopal Madhya Pradesh, India Bansal News Full time

**Hiring For Bansal Hospital Bhopal**

**Location_ Bhopal (On-site)**

**Profile _TPA Manager**

Looking for third-party administrator (TPA) who **provides administrative services for self-funded health plans, sometimes referred to as self-insured health plans, in the health insurance industry**.

**Responsibilities**

Coordinating all activities related to patient claims and insurance.

Supervise the process of filing and tracking insurance claims for patients, ensuring claims are submitted timely and correctly.

Ensure regular follow-up on pending or rejected claims and coordinate with TPAs for resubmission or dispute resolution.

Assist patients in understanding their insurance coverage, including what services are covered, co-payments, and out-of-pocket expenses.

Ensure that all claims processes are compliant with hospital policies, TPA agreements, and insurance regulations.

Collaborate with various hospital departments (billing, finance, medical, etc.) to ensure accurate documentation for claims and smooth processing of patient records.

Monitor and track the status of submitted claims, pending approvals, and settlements, ensuring that TPA services meet performance benchmarks.

Coordinate with hospital billing departments for adjustments in patient bills based on insurance approvals and coverage terms.

**Skills Required**:
Knowledge of Health Insurance and TPA Processes.

Communication and Interpersonal Skills.

Technical Skills and Software Proficiency.

Regulatory and Compliance Knowledge.

Risk and Fraud Management.

Schedule:

- Day shift

**Experience**:

- Mediclaims: 5 years (required)

Work Location: In person

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