JOB DESCRIPTION – TPA / CASHLESS CLAIMS

Organization: Dr. Shroff’s Charity Eye Hospital, Delhi
Location: Daryaganj, Delhi
Department: TPA / Insurance Desk

Role Summary

Responsible for managing the end-to-end cashless and insurance claim process, including coordination with TPAs, ECHS, CGHS, PSUs and other insurance/government health schemes.

Key Responsibilities

- Handle cashless claims and reimbursement cases from registration/admission to final settlement.
- Manage cases under TPA, ECHS, CGHS, PSU and other insurance schemes.
- Verify patient eligibility, scheme/policy details, coverage and required documents.
- Process and submit pre-authorisation requests and obtain timely approvals.
- Coordinate with TPAs, ECHS/CGHS authorities, PSU representatives and insurance companies.
- Follow up for pending approvals, queries, enhancements and final authorisations.
- Coordinate with doctors, billing, medical records and other departments for claim-related documentation.
- Prepare and submit final claims within defined timelines.
- Verify claim documents and ensure completeness before submission.
- Handle claim queries, deductions, rejections and resubmissions.
- Maintain records of cashless cases, approvals,



pending claims and settlements.
- Monitor outstanding claims and ensure timely follow-up for settlement.
- Resolve patient queries related to cashless facilities, approvals and claim status.
- Prepare MIS/reports related to TPA, ECHS, CGHS, PSU and insurance claims.
- Ensure compliance with applicable TPA, CGHS, ECHS, PSU and hospital guidelines/policies.

Desired Skills

- Strong knowledge of TPA and cashless claim processing.
- Hands-on experience with ECHS, CGHS and PSU medical claims.
- Knowledge of pre-authorisation, claim submission, query resolution and settlement processes.
- Good communication, coordination and follow-up skills.
- Proficiency in MS Excel and hospital/insurance-related software.
- Ability to manage multiple claims and meet defined timelines.

Qualification & Experience

Qualification: Graduate in any discipline.
Experience: 2–5 years of relevant experience in TPA / Cashless Claims / ECHS / CGHS / PSU / Hospital Insurance Desk.

Pay: ₹20,000.00 - ₹22,000.00 per month

Advantages:

- Provident Fund

Work Location: In person

📌 TPA Executive (Delhi)
🏢 Dr. Shroff's Charity Eye Hospital
📍 Delhi