TPA Claim Executive-
4 days ago
Role & responsibilities
- Coordinate with patients, TPAs, and insurance companies for pre-authorization, approval, and final claim settlements.
- Prepare and submit claim documents and bills to TPAs/insurance companies in the prescribed format.
- Follow up regularly with TPAs for claim status, pending queries, and settlement updates.
- Verify patient insurance details, coverage, and eligibility before admission and discharge.
- Maintain accurate and up-to-date records of all claims submitted and settled.
- Handle rejections, discrepancies, and short settlements by coordinating with relevant departments and TPAs.
- Ensure compliance with hospital policies and TPA/insurance requirements.
- Generate periodic reports on claims pending, approved, rejected, and under process.
- Coordinate with the billing department to ensure correct patient billing as per TPA tariff and agreement.
- Support audits and maintain proper documentation for all claim-related activities.
Preferred candidate profile
- Good knowledge of TPA, insurance processes, and hospital billing systems.
- Strong communication and coordination skills.
- Attention to detail and accuracy in documentation.
- Proficiency in MS Excel and hospital billing software (HIS).
- Ability to manage multiple claims and meet deadlines.
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