Job Title: TPA Care Executive

Location: Optimus Hospital, Sector 88, Gurugram

: We are seeking a dedicated and empathetic individual to join our team as a TPA Care Executive at Optimus Hospital, Gurugram. In this role, you will be responsible for facilitating cashless and reimbursement claims for patients. The role involves ensuring timely approvals, accurate documentation, and seamless communication between patients, doctors, hospital departments, and insurance providers.

Responsibilities:

- Handle cashless hospitalization requests and coordinate with insurance companies for approvals.
- Verify patient insurance eligibility, policy coverage, and documentation requirements.
- Collect, review, and submit pre-authorization form, enhancement, and discharge claim documents.
- Assist the patient in filing of Reimbursement claim and follow up for claim approvals, queries, and settlements.
- Counsel patients and attendants regarding insurance procedures, coverage, and claim status.
- Coordinate with billing, admissions, medical records, and clinical teams for claim processing.
- Ensure timely submission of final bills, discharge summaries, investigation reports, and other required documents.




- Maintain records of approvals, rejections, settlements, and outstanding claims.
- Resolve claim-related issues and escalate complex cases when required.
- Ensure compliance with hospital policies, insurance guidelines, and regulatory requirements.
- Prepare daily and monthly reports related to TPA activities and claim status.

Qualifications:

- Bachelor's degree in healthcare administration, business administration, or related field preferred.
- Minimum of 2 years of experience in a hospital setting or insurance company, specifically in dealing with third-party administrators (TPAs) and health insurance processes.
- Strong interpersonal skills with the ability to effectively communicate complex information to patients.
- Excellent organizational skills and attention to detail.
- Proficiency in computer applications like Microsoft Office.
- Ability to work independently and collaboratively in a quick-paced environment.
- Commitment to maintaining confidentiality and adhering to ethical standards.
- Knowledge of medical terminology.

📌 Tpa Executive (Gurugram)
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