We are looking for an experienced TPA Coordinator to manage and coordinate insurance/TPA-related processes, including cashless approvals, pre-authorizations, claim documentation, discharge approvals, and coordination with insurance companies and Third-Party Administrators. The candidate should have robust knowledge of hospital billing, insurance procedures, and TPA documentation.

- Key Responsibilities

- Coordinate with TPAs, insurance companies, patients, doctors, billing and medical records departments.

- Handle cashless admission and pre-authorization processes.

- Prepare and submit pre-authorization requests with complete and accurate documentation.

- Follow up with TPAs/insurance companies for approval, enhancement and final authorization.

- Coordinate for cashless discharge approval and ensure timely processing.

- Verify insurance eligibility, policy details, coverage and applicable terms.

- Ensure proper collection and submission of required patient documents.

- Check medical records, investigation reports, prescriptions, bills and other documents required for claims.

- Coordinate with the billing team regarding insurance billing, deductions and claim settlements.

- Follow up on pending claims, queries, deductions and rejections.

- Maintain proper records of pre-authorizations, approvals, discharges, claims and settlements.

- Communicate professionally with patients and their attendants regarding insurance/TPA procedures.

- Resolve TPA-related queries and coordinate with concerned hospital departments for timely action.

- Ensure compliance with hospital policies, insurance guidelines and TPA requirements.





- Prepare daily/weekly/monthly TPA MIS reports and pending case reports.

- Identify documentation gaps and ensure timely correction to avoid claim delays or rejections.

- Maintain confidentiality of patient and insurance-related information.

- Required Skills

- Strong knowledge of TPA, insurance and cashless hospitalization processes.

- Good understanding of hospital billing and claim documentation.

- Excellent communication and coordination skills.

- Good follow-up and problem-solving abilities.

- Proficiency in MS Office/Excel and hospital information systems (HIS).

- Ability to work under pressure and manage multiple cases simultaneously.

- Strong documentation and record-keeping skills.

- Patient-friendly and professional approach.

- Eligibility

- Graduate in any discipline; preference may be given to candidates with a background in Hospital Management, Healthcare Administration, Medical Records or related fields.

- 4–5 years of relevant experience in a hospital/healthcare setup is mandatory.

- Experience in handling TPA/insurance desk, cashless approvals and hospital claims will be preferred.

- Key Performance Indicators (KPIs)

- Timely processing of pre-authorization requests.

- Faster turnaround time for cashless approvals and discharge approvals.

- Reduction in pending TPA cases and claim queries.

- Accurate and complete documentation.

- Effective follow-up on pending claims and settlements.

- Reduction in claim rejection/deduction due to documentation errors.

- Patient satisfaction and effective coordination with internal departments.

Pay: ₹35,000.00 - ₹40,000.00 per month

Work Location: In person

📌 TPA Co-ordinator (India)
🏢 Shri Sai Hospital
📍 India