JOB PROFILE
Designation
Executive- TPA& Insurance
Grade
B04/EXEC/L2
Location
Thane
Department
Hospitality
Qualification
Graduate in any discipline (Healthcare Administration preferred).
Qualified Experience
1–3 years of experience in hospital TPA/insurance operations preferred.
Familiarity with hospital billing systems and HIS preferred.
Role Purpose
To ensure smooth and timely processing of insurance and TPA-related activities including cashless approvals, claim documentation, billing coordination, and settlement follow-up, while supporting patients and maintaining compliance with hospital and insurance guidelines for efficient revenue realization..
Key Responsibilities
- Coordinate with TPAs and insurance companies for cashless authorization and approvals.
- Verify patient insurance eligibility, policy coverage, and documentation requirements.
- Prepare, compile, and submit claim documents within defined timelines.
- Follow up on pending approvals, claim settlements, and reimbursement status.
- Ensure accuracy of billing, coding, and supporting medical documents.




- Address queries and discrepancies raised by TPAs/insurance companies.
- Maintain records of approvals, denials, settlements, and outstanding claims.
- Coordinate with clinical, billing, and front office teams for smooth claim processing.
- Ensure compliance with insurance protocols, NABH standards, and hospital policies.
- Generate MIS reports related to TPA claims, rejections, and revenue tracking.
- Support patients and attendants regarding insurance procedures and claim status.
- Escalate delayed or disputed claims to higher authorities when required.

Skills & Competencies
- Knowledge of TPA and health insurance processes.
- Good communication and coordination skills.
- Basic understanding of medical terminology and hospital billing.
- Proficiency in MS Office and Hospital Information Systems (HIS).
- Attention to detail and documentation accuracy.
- Ability to work under pressure and manage time

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