Senior Executive TPA

2 hours ago

Delhi NCR, India AIG Business Solution Full time ₹ 9,00,000 - ₹ 12,00,000 per year

Job Title: Senior Executive TPA & Recovery

Location: Dwarka

Department: Billing / Finance / TPA

Reporting To: Manager Billing & TPA / Finance Head

Experience Required: 3–6 years in hospital TPA billing, claim submission, and recovery

Qualification: Graduate or Postgraduate (Preferably in Commerce, Hospital Administration, or Healthcare Management)

Job Summary

The Senior Executive – TPA & Recovery is responsible for managing Third Party Administrator (TPA) operations, including cashless admission processing, pre-authorization, final billing, claim submission, and recovery follow-ups. The role ensures timely coordination between the hospital, patients, and insurance companies to maximize reimbursement and maintain healthy cash flow.

Key Responsibilities

1. TPA Coordination & Admission Management

  • Coordinate with patients, consultants, and TPA representatives for cashless and insurance-based admissions.
  • Verify policy details, coverage, and exclusions at the time of admission.
  • Prepare and submit pre-authorization requests to respective TPAs or insurance companies.
  • Track and update the status of pre-auth approvals and communicate with concerned departments.

2. Billing & Documentation

  • Ensure timely and accurate preparation of interim and final bills as per the treatment and approved tariff.
  • Check completeness of documentation (doctor notes, discharge summary, investigation reports, etc.) before final claim submission.
  • Coordinate with the billing and MRD teams for discharge documents required for claim settlement.

3. Claim Submission & Recovery

  • Submit final claims to TPAs/insurance companies within TAT.
  • Regularly follow up on pending or short-settled claims and maintain recovery trackers.
  • Coordinate with TPAs for query resolution, short payments, re-submissions, and reconciliations.
  • Maintain and update claim MIS reports daily/weekly/monthly.

4. Financial & Audit Compliance

  • Ensure claim settlements are accurately recorded in the hospital's financial system.
  • Assist in reconciliation of TPA accounts with the Finance Department.
  • Support internal and external audits by providing claim and recovery data as required.

5. Communication & Coordination

  • Liaise effectively with the medical, billing, and MRD teams to resolve TPA-related issues.
  • Maintain healthy relationships with TPA executives, insurance coordinators, and corporate clients.
  • Provide patients and attendants with transparent communication regarding their claim status.

Skills & Competencies

  • In-depth knowledge of TPA/insurance claim process, pre-auth, and recovery procedures.
  • Strong understanding of medical terminology, billing codes, and tariff structures.
  • Proficiency in MS Excel, HIS (Hospital Information System), and TPA portals.
  • Excellent communication and negotiation skills.
  • Strong analytical, follow-up, and problem-solving ability.
  • Attention to detail and ability to work under tight deadlines.

Work Schedule

  • Days: Monday to Saturday
  • Timings: 9:00 AM – 6:00 PM (may vary as per hospital policy)

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