Job Description - TPA Executive (2:00 PM to 9:00 PM Shift)

Position: TPA Executive
Department: TPA/Insurance & Ayushman Desk
Shift Timing: 2:00 PM to 9:00 PM
Location: Sanjivini Super Speciality Hospital

Job Summary

The TPA Executive will be responsible for managing all TPA and insurance-related activities, including cashless hospitalization processes and Ayushman Bharat (PM-JAY) schemes. The role involves patient registration, documentation, obtaining approvals, claim processing, and coordination with insurance companies, TPAs, and hospital departments to ensure smooth patient services and timely claim settlements.

Key Responsibilities
Handle cashless hospitalization cases and coordinate with TPAs and insurance companies for approvals and claim settlements.
Verify insurance eligibility and process pre-authorization requests with all required documentation.
Manage all activities related to Ayushman Bharat (PM-JAY), including beneficiary verification, patient registration, package selection, and claim submission.




Ensure proper documentation and timely submission of Ayushman and TPA claims as per guidelines.
Coordinate with doctors, nursing staff, billing, and front office teams to collect necessary medical records and treatment updates.
Follow up on pending approvals, queries, and claim settlements from TPAs and Ayushman authorities.
Explain insurance coverage, Ayushman perks, package details, and claim procedures to patients and attendants.
Maintain accurate records of cashless admissions, approvals, claims, rejections, and discharged cases.
Prepare daily and monthly reports related to TPA and Ayushman cases.
Ensure compliance with hospital policies, TPA guidelines, and Ayushman Bharat operational protocols.
Assist in audits, inspections, and documentation requirements related to insurance and Ayushman schemes.
Maintain confidentiality of patient information and all claim-related documents.

Required Qualifications
Graduate in any di

📌 Tpa Executive Lucknow
🏢 SANJIVINI HOSPITAL & RESEARCH CENTER
📍 Lucknow