Job Overview The TPA Claims Executive. To help team in filling error free health claim end to end & resolving query raised. To reconcile claim filed vs claim received. The goal is to ensure fast and accurate claim processing for hospital. Key Responsibilities • Reconciliation: Review Claim filled & claim received. • Claim Assessment: Review Claim status & reply to query. • Verification: Check policy terms, exclusions, Errors and deductions. • Adjudication: Reply to query & coordinate for cashless claims. • Hospital Coordination: Network with empanelled hospitals for billing updates. • Data Management: Enter accurate claim details into the core CRM/TPA software. • Required Skills & Qualifications • Education: Bachelors degree • Experience: 1 to 4 years in health insurance for Pvt & Govt Claims. • Medical Knowledge:



Strong grasp of medical terminology, ICD codes, and treatments. • Communication: Clear verbal and written skills to handle disputes. • Tech Savvy: Proficiency in MS Excel and insurance claim management systems.

- Manage claims processing, adjudication, and settlement for health insurance policies.

- Oversee data management, including ICD coding and CRM system maintenance.

- Ensure accurate billing and reconciliation of accounts receivable (AR) and payable (AP).

- Conduct audits to identify areas of improvement in financial management.

- Verify patient eligibility and advantages before processing claims.

📌 Tpa Executive (Noida)
🏢 Rama Medicare
📍 Noida