Verified Job
Healthcare
TPA Executive
Healthcare
#755934
Remote / WFH
Supreme Hospital · Faridabad, Haryana ·
Job Description
Job description
Key Responsibilities
• Handle cashless hospitalization requests and insurance claim processing.
• Verify patient insurance eligibility and policy coverage.
• Submit pre-authorization requests to TPAs and insurance companies.
• Coordinate with doctors, nursing staff, billing, and medical records departments for required documents.
• Prepare and submit final bills, discharge summaries, investigation reports, and other claim-related documents.
• Follow up with TPAs and insurance companies for approvals, queries, and claim settlements.
• Resolve claim discrepancies and respond to insurance queries promptly.
• Ensure accurate documentation and compliance with TPA and insurance guidelines.
• Coordinate with the billing department for insurance billing and claim reconciliation.
• Maintain records of approvals, rejections, pending claims, and settlements.
• Support patients by explaining insurance procedures, coverage, and documentation requirements.
• Prepare daily, weekly, and monthly reports on claims, approvals, rejections, and outstanding payments.
Qualifications
• Bachelor's degree in Commerce, Business Administration, Hospital Administration, Healthcare Management, or a related field.
• Certification in Health Insurance or Hospital Administration is an added advantage.
Experience
• 1–3 years of experience in hospital TPA operations, medical insurance, billing, or claims management.
• Freshers with relevant education may also be considered.
Required Skills
• Knowledge of health insurance, TPA processes, and cashless claim procedures.
• Understanding of hospital billing and medical documentation.
• Strong communication and coordination skills.
• Attention to detail and accuracy in documentation.
• Good problem-solving and follow-up skills.
• Proficiency in Hospital Information Systems (HIS), Microsoft Excel, and Microsoft Office.
• Ability to work under pressure and meet claim submission deadlines.
Key Performance Indicators (KPIs)
• Timely submission of pre-authorizations and claims.
• Claim approval and settlement rate.
• Reduction in claim rejections and document deficiencies.
• Turnaround time (TAT) for approvals and settlements.
• Accuracy of billing and claim documentation.
• Patient and insurance partner satisfaction.
Pay: ₹25,000.00 - ₹35,000.00 per month
Work Location: In person
Key Responsibilities
• Handle cashless hospitalization requests and insurance claim processing.
• Verify patient insurance eligibility and policy coverage.
• Submit pre-authorization requests to TPAs and insurance companies.
• Coordinate with doctors, nursing staff, billing, and medical records departments for required documents.
• Prepare and submit final bills, discharge summaries, investigation reports, and other claim-related documents.
• Follow up with TPAs and insurance companies for approvals, queries, and claim settlements.
• Resolve claim discrepancies and respond to insurance queries promptly.
• Ensure accurate documentation and compliance with TPA and insurance guidelines.
• Coordinate with the billing department for insurance billing and claim reconciliation.
• Maintain records of approvals, rejections, pending claims, and settlements.
• Support patients by explaining insurance procedures, coverage, and documentation requirements.
• Prepare daily, weekly, and monthly reports on claims, approvals, rejections, and outstanding payments.
Qualifications
• Bachelor's degree in Commerce, Business Administration, Hospital Administration, Healthcare Management, or a related field.
• Certification in Health Insurance or Hospital Administration is an added advantage.
Experience
• 1–3 years of experience in hospital TPA operations, medical insurance, billing, or claims management.
• Freshers with relevant education may also be considered.
Required Skills
• Knowledge of health insurance, TPA processes, and cashless claim procedures.
• Understanding of hospital billing and medical documentation.
• Strong communication and coordination skills.
• Attention to detail and accuracy in documentation.
• Good problem-solving and follow-up skills.
• Proficiency in Hospital Information Systems (HIS), Microsoft Excel, and Microsoft Office.
• Ability to work under pressure and meet claim submission deadlines.
Key Performance Indicators (KPIs)
• Timely submission of pre-authorizations and claims.
• Claim approval and settlement rate.
• Reduction in claim rejections and document deficiencies.
• Turnaround time (TAT) for approvals and settlements.
• Accuracy of billing and claim documentation.
• Patient and insurance partner satisfaction.
Pay: ₹25,000.00 - ₹35,000.00 per month
Work Location: In person
