JOB PROFILE

Designation

Executive- TPA& Insurance

Grade

B04/EXEC/L2

Location

Thane

Department

Hospitality

Qualification

Graduate in any discipline (Healthcare Administration preferred).

Professional 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.

- Positive 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 timelines.

- Key Relationships

Key Relationships

- External: communicates with patients and their families.

- Internal: coordinates with Consultants, nurses, billing, Ward Coordinator, and OT.

Please Note: is only a general guideline and will change depending on the organizational requirement.

📌 Executive-TPA and Insurance (Thane)
🏢 Jupiter Hospital
📍 Thane