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TPA Co-ordinator

2 weeks ago

Gurgaon, Haryana, India Swastik Hospital, Sector 62 Gurugram Haryana Full time ₹ 1,04,000 - ₹ 1,30,878 per year

TPA Coordinator acts as a bridge between the hospital, insurance companies, and patients, handling all matters related to cashless insurance claims, pre-authorizations, and reimbursements. They ensure smooth processing of documents and compliance with TPA policies for both insured patients and the hospital.

Key Roles & Responsibilities

Insurance Processing

  • Facilitate pre-authorization for cashless treatments by submitting medical documents to TPAs.
  • Track approval status and communicate decisions to patients and billing team.
  • Handle reimbursement cases by preparing and submitting proper documentation to insurance companies.

Documentation & Coordination

  • Collect and verify required documents from patients (ID proof, insurance card, policy documents, etc.).
  • Coordinate with doctors and departments to get accurate treatment details and discharge summaries.
  • Submit final bills and medical records to TPA for settlement.

Patient Interaction

  • Explain the insurance claim process to patients and their families.
  • Help patients choose eligible insurance packages or inform them about exclusions.
  • Handle patient queries or grievances related to insurance.

Billing & Claims Follow-Up

  • Work closely with the billing department to prepare and finalize claims.
  • Follow up with TPA for pending or rejected claims.
  • Maintain records of all claims filed, approvals, rejections, and payments received.

Compliance & Audit

  • Ensure compliance with IRDAI (Insurance Regulatory and Development Authority of India) and hospital policies.
  • Prepare reports for hospital management or audits as needed.

Skills Required

  • Knowledge of medical insurance processes
  • Familiarity with hospital billing software (e.g., MediAssist, MedNet, FHPL, HealthIndia)
  • Good communication and interpersonal skills
  • Attention to detail in documentation
  • Ability to handle pressure and coordinate across departments
  • Basic medical terminology (useful when handling diagnosis/procedures)

Qualification

  • Minimum: Graduate (any stream, preferably B.Com, BBA, or BA)
  • Preferred: Diploma or certification in Hospital Administration, TPA, or Medical Billing
  • Basic computer and typing skills are essential
  • Previous experience in hospital front office or billing is a plus

Typical Work Environment

  • Hospital Front Office / Insurance Desk

Job Types: Full-time, Permanent

Pay: From ₹20,000.00 per month

Work Location: In person