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: 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 benefits before processing claims.

📌 Tpa Manager (Baghpat)
🏢 Rama Medicare
📍 Baghpat