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:



Robust grasp of medical terminology, ICD codes, and treatments. • Communication: Explicit 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