Key Responsibilities
Handle cashless hospitalization requests and insurance claim processing.
Verify patient insurance eligibility and policy coverage.
Submit pre-authorization requests to TPAs and insurance companies.
Coordinate with doctors, nursing staff, billing, and medical records departments for required documents.
Prepare and submit final bills, discharge summaries, investigation reports, and other claim-related documents.
Follow up with TPAs and insurance companies for approvals, queries, and claim settlements.
Resolve claim discrepancies and respond to insurance queries promptly.
Ensure accurate documentation and compliance with TPA and insurance guidelines.
Coordinate with the billing department for insurance billing and claim reconciliation.
Maintain records of approvals, rejections, pending claims, and settlements.
Support patients by explaining insurance procedures, coverage, and documentation requirements.
Prepare daily, weekly, and monthly reports on claims, approvals, rejections, and outstanding payments.

Qualifications




Bachelor's degree in Commerce, Business Administration, Hospital Administration, Healthcare Management, or a related field.
Certification in Health Insurance or Hospital Administration is an added advantage.

Experience
1–3 years of experience in hospital TPA operations, medical insurance, billing, or claims management.
Freshers with relevant education may also be considered.

Required Skills
Knowledge of health insurance, TPA processes, and cashless claim procedures.
Understanding of hospital billing and medical documentation.
Robust communication and coordination skills.
Attention to detail and accuracy in documentation.
Positive problem-solving and follow-up skills.
Proficiency in Hospital Information Systems (HIS), Microsoft Excel, and Microsoft Office.
Ability to work under pressure and meet claim submission deadlines.

Key Performance Indicators (KPIs)
Timely submission of pre-author

📌 Tpa Executive Faridabad
🏢 Supreme Hospital
📍 Faridabad