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
Solid 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.
Valuable 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 Central Delhi (India)
🏢 Dr. Shroff's Charity Eye Hospital
📍 India