TPA Executive

1. Educational Qualifications

• Bachelor's degree in business administration, Healthcare Management, Insurance, Finance, or related field
• BBA or postgraduate diploma in Healthcare Management / Insurance preferred

2. Work Experience

• Minimum 2–3 years' experience in hospital TPA management, health insurance, or claims processing
• Experience handling TPA coordination, claim settlements, and insurance approvals in a hospital environment
• Knowledge of insurance policies, claim procedures, and regulatory guidelines

3. Core Skills & Knowledge

• Managing and coordinating with TPAs for smooth claims processing
• Understanding of insurance policy terms, claim documentation, pre-authorization, and discharge approvals
• Monitoring and follow-up of claim rejections, disputes, and escalations
• Preparing reports on claim status, approvals, denials, and financial reconciliation

4. Technical Skills

• Familiarity with Hospital Information Systems (HIS) and TPA portals
• Proficiency in MS Excel for data analysis and reporting
• Use of email and communication tools for vendor coordination

5. Communication & Negotiation Skills

• Strong verbal and written communication skills for interaction with insurance companies, hospital departments, and patients
• Negotiation skills to resolve claim disputes and expedite approvals

6. Compliance & Documentation

• Ensuring timely and accurate submission of documents as per insurance and hospital policies
• Maintaining audit-ready claim files and records
• Knowledge of healthcare regulations and insurance compliance requirements

7. Performance Indicators

• Claim settlement turnaround time
• Reduction in claim rejection rates
• Accuracy and completeness of claim documentation

Job Types: Full-time, Permanent

Pay: ₹12, ₹25,000.00 per month

Benefits:

• Leave encashment
• Paid sick time
• Paid time off
• Provident Fund

Education:

• Diploma (Preferred)

Experience:

• Hospital TPA: 2 years (Preferred)

Work Location: In person