Key Responsibilities of a TPA Coordinator

Core Responsibilities1. Insurance & TPA Coordination

- Coordinate with insurance companies and TPAs for cashless hospitalization approvals.
- Handle pre-authorization and claim documentation processes.
- Follow up on pending approvals, claim settlements, and reimbursement status.
- Maintain robust communication with TPAs, insurance representatives, and hospital departments.

2. Patient Assistance

- Guide patients and attendants regarding insurance procedures and required documents.
- Explain cashless policies, coverage details, exclusions, and claim processes.
- Assist patients during admission and discharge formalities related to insurance.

3. Documentation Management

- Verify patient insurance documents and policy details.
- Ensure accurate preparation and submission of claim forms, bills, discharge summaries, investigation reports, and supporting documents.
- Maintain records of approvals, denials, claims, and settlements.

4. Billing & Claim Processing





- Coordinate with the billing department for accurate insurance billing.
- Review hospital bills as per TPA guidelines and package rates.
- Resolve billing discrepancies and claim-related queries.

5. Claim Follow-Up & Settlement

- Track pending claims and ensure timely settlement.
- Handle claim rejections, denials, deductions, and resubmissions.
- Prepare daily and monthly MIS reports related to TPA operations.

6. Compliance & Policy Adherence

- Ensure compliance with hospital policies, insurance regulations, and TPA guidelines.
- Keep updated with changes in insurance policies and healthcare regulations.

7. Coordination with Internal Departments

- Work closely with doctors, nursing staff, front office, medical records, and accounts departments.
- Ensure smooth patient discharge process after final approval.

Pay: ₹11,000.00 - ₹20,000.00 per month

Work Location: In person

📌 TPA Coordinator (India)
🏢 Sentra Hospital
📍 India