– TPA EXECUTIVE

Position: TPA Executive

Location: Sanjivini Super Speciality Hospital, Gomti Nagar, Lucknow

Experience: 1–3 years in Hospital TPA/Insurance Desk preferred

Job Summary

We are looking for a TPA Executive who can independently handle hospital insurance, TPA, cashless and Ayushman Bharat PM-JAY cases. The candidate should have good knowledge of pre-authorization, claim processing, documentation, query handling and settlement procedures.

Key Responsibilities

- Handle TPA, Insurance and Cashless patient cases from admission to discharge.
- Verify patient insurance/TPA eligibility and required documents.
- Coordinate with insurance companies, TPAs, patients and hospital departments.
- Prepare and submit pre-authorization requests and follow up for approvals.
- Handle insurance/TPA queries and provide required documents within the given timeline.
- Prepare and submit final claims with complete medical and billing documents.
- Track claim status, pending queries, rejections and settlements.
- Maintain proper records of all TPA and insurance cases.
- Coordinate with billing, medical records, doctors and other departments for claim documentation.
- Ensure timely submission of discharge summaries, investigation reports, bills and other required documents.

Ayushman Bharat / PM-JAY Responsibilities




- Handle Ayushman Bharat PM-JAY cases and beneficiary verification.
- Have working knowledge of PM-JAY TMS/BIS processes.
- Register and verify beneficiaries as per applicable process.
- Raise and follow up on pre-authorization requests.
- Ensure required documents and treatment details are uploaded correctly.
- Coordinate with doctors and hospital departments for package selection and documentation.
- Update treatment and discharge details in the portal.
- Initiate and follow up on Ayushman claims until approval/settlement.
- Handle claim queries, deficiencies and re-submission requirements.
- Maintain proper records of Ayushman cases and claim status.

The PM-JAY workflow includes beneficiary registration, pre-authorization, treatment updates, discharge, claim initiation, claim verification and settlement.

Required Skills

- Good knowledge of TPA & Insurance claim processing.
- Strong knowledge of Ayushman Bharat PM-JAY.
- Knowledge of pre-auth and claim documentation.
- Good computer and MS Office skills.
- Valuable communication and coordination skills.
- Ability to handle multiple cases and follow up within deadlines.
- Knowledge of hospital billing and medical documentation will be an advantage.

Pay: ₹18,000.00 - ₹20,000.00 per month

Work Location: In person

📌 TPA Executive (Lucknow)
🏢 sanjivini hospital u0026 research center
📍 Lucknow