1-5 Years in Hospital TPA or Medical Insurance Handling
Job Summary
The TPA & Insurance Executive is responsible for handling cashless hospitalization processes, insurance documentation, patient coordination, claim processing, and communication with insurance companies and TPAs. The role ensures smooth approval and settlement of patient insurance claims as per hospital and insurance guidelines.
Key Responsibilities
- Handle all cashless and reimbursement insurance cases.
- Coordinate with TPAs and insurance companies for approvals and claim settlements.
- Verify patient insurance eligibility and policy details.
- Prepare and submit pre-authorization documents.
- Follow up for approval, enhancement, and final settlement.
- Maintain proper documentation of insurance files and patient records.
- Coordinate with doctors, billing department, and nursing staff for required documents.
- Explain insurance procedures and coverage details to patients and attendants.
- Resolve insurance claim-related queries and disputes.
- Ensure timely submission of discharge summaries, bills, investigation reports, and claim forms.
- Track pending claims and maintain MIS reports.
- Maintain confidentiality of patient and insurance data.
- Ensure compliance with hospital policies and insurance guidelines.
Required Skills:
- Knowledge of TPA and medical insurance processes
- Valuable communication and coordination skills
- Basic knowledge of hospital billing
- Knowledge of cashless claim processing
- Computer proficiency (MS Excel, Hospital Software)
- Documentation and follow-up skills
- Problem-solving ability
Educational Qualification
- Graduate in any field
Preferred:
- MBA in Hospital Administration
- BBA / B.Com / Healthcare Management
Preferred Experience
Experience in handling:
- Cashless Mediclaim
- Insurance approvals
- Hospital billing
- TPA portals and documentation