Key Responsibilities of a TPA Coordinator

Core Responsibilities1. Insurance & TPA Coordination
Coordinate with insurance companies and TPAs for cashless hospitalization approvals.
Handle pre-authorization and claim documentation processes.
Follow up on pending approvals, claim settlements, and reimbursement status.
Maintain robust communication with TPAs, insurance representatives, and hospital departments.
Patient Assistance
Guide patients and attendants regarding insurance procedures and required documents.
Explain cashless policies, coverage details, exclusions, and claim processes.
Assist patients during admission and discharge formalities related to insurance.
Documentation Management
Verify patient insurance documents and policy details.
Ensure accurate preparation and submission of claim forms, bills, discharge summaries, investigation reports, and supporting documents.
Maintain records of approvals, denials, claims, and settlements.
Billing & Claim Processing




Coordinate with the billing department for accurate insurance billing.
Review hospital bills as per TPA guidelines and package rates.
Resolve billing discrepancies and claim-related queries.
Claim Follow-Up & Settlement
Track pending claims and ensure timely settlement.
Handle claim rejections, denials, deductions, and resubmissions.
Prepare daily and monthly MIS reports related to TPA operations.
Compliance & Policy Adherence
Ensure compliance with hospital policies, insurance regulations, and TPA guidelines.
Keep updated with changes in insurance policies and healthcare regulations.
Coordination with Internal Departments
Work closely with doctors, nursing staff, front office, medical records, and accounts departments.
Ensure smooth patient discharge process after final approval.

Pay: ₹11,000.00 - ₹20,000.00 per month

Work Location: In person

📌 Tpa Coordinator Malad East (India)
🏢 Sentra Hospital
📍 India