Job Description
We are hiring a TPA Executive to manage and oversee the entire insurance claims process. Your key responsibility will be to ensure the seamless coordination of cashless and reimbursement claims with Third Party Administrators (TPAs) and insurance companies, in accordance with hospital policies and regulatory standards.
Key Responsibilities:
Process and manage insurance and cashless claims end-to-end.
Coordinate with TPAs and insurance companies for approvals and settlements.
Ensure accurate and timely billing, documentation, and claim submissions.
Verify patient insurance details and eligibility as per policy terms.
Resolve claim-related queries and discrepancies with internal teams and external agencies.
Maintain updated knowledge of insurance regulations and TPA guidelines.
Prepare and submit regular reports on claim status and settlements.
Skill Requirement
The ideal candidate should have prior experience in TPA/insurance claims processing, preferably in a hospital or healthcare setting, along with strong communication and documentation skills.
Required Competencies:
Proven experience in handling TPA and insurance claims.
Good understanding of healthcare billing and cashless claim procedures.
Strong coordination and follow-up skills with TPAs/insurance providers.
Attention to detail and ability to work under process deadlines.
Proficiency in hospital management software and MS Office.
Knowledge of regulatory and compliance guidelines related to health insurance.