Verify policyholder details, insurance coverage, eligibility, and policy validity before processing claims.
Coordinate and process cashless authorization requests in accordance with the terms and conditions of the insurance policy.
Scrutinize medical documents, hospital bills, prescriptions, diagnostic reports, discharge summaries, and other claim-related documents for completeness and accuracy.
Coordinate with hospitals, insurance companies, policyholders, and medical teams to facilitate smooth and timely claim processing.
Monitor and follow up on pending pre-authorizations, discharge approvals, reimbursement claims, and other outstanding cases.
Ensure accurate entry and timely updating of claim and patient information in the TPA system.
Address policyholder and hospital queries professionally and provide appropriate assistance regarding claim procedures, documentation, and coverage.
Identify discrepancies, incomplete documentation,



and potential claim issues and escalate them to the appropriate authority for resolution.
Maintain accurate records and ensure proper documentation of all claim-related activities.
Adhere strictly to organizational SOPs, insurance policy guidelines, regulatory requirements, and data confidentiality standards.
Prepare and maintain periodic reports relating to claims, approvals, pending cases, and service performance.
Coordinate with internal and external stakeholders to resolve complaints and ensure a high level of customer satisfaction.
Maintain skilled communication and build effective working relationships with hospitals, insurers, and policyholders.
Ensure that all assigned cases are handled accurately, efficiently, and within the prescribed turnaround time (TAT).

Pay: ₹25,000.00 - ₹30,000.00 per month

Advantages
Cell phone reimbursement
Versatile schedule

Work Location: In person

📌 Tpa Executive Sahibzada Ajit Singh Nagar (India)
🏢 YUKTI HERBS AYURVEDA AND PANCHKARMA HOSPITAL
📍 India