TPA Claim Executive-

1 day ago

Jaipur, Rajasthan, India Rungta Hospital Full time ₹ 9,00,000 - ₹ 12,00,000 per year

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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