TPA Executive

1 day ago

Greater Noida, Uttar Pradesh, India KAILASH HOSPITAL Full time ₹ 9,00,000 - ₹ 12,00,000 per year

The TPA (Third Party Administrator) Executive manages and coordinates health insurance processes between patients, insurance companies, and the hospital. The role ensures smooth processing of cashless claims, pre-authorization approvals, and reimbursement settlements while providing excellent patient support.

Key Responsibilities:

  • Insurance Coordination:
  • Liaise with TPAs, insurance companies, and patients for cashless and reimbursement claims.
  • Verify patient insurance eligibility and coverage prior to admission or treatment.
  • Obtain pre-authorization approvals for planned procedures and surgeries.
  • Claims Management:
  • Process insurance claims accurately and follow up for timely settlement.
  • Resolve claim rejections or discrepancies with insurance companies.
  • Maintain records of all TPA communications and claim documentation.
  • Patient Support:
  • Assist patients with insurance-related queries and documentation.
  • Guide patients through hospital billing and insurance procedures.
  • Ensure patient satisfaction regarding insurance services.
  • Reporting & Compliance:
  • Prepare daily, weekly, and monthly TPA reports.
  • Ensure compliance with hospital policies and insurance regulations.
  • Coordinate with the billing and accounts department for smooth financial operations.

Qualifications:

  • Education: Graduate in any discipline (preferably in Business Administration, Healthcare Management, or related field).
  • Experience: 1–3 years of experience in TPA, health insurance, or hospital administration.

Job Type: Full-time

Work Location: In person

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