Department: Insurance/TPA Services

Reports to: TPA Manager/Hospital Administrator

Job Summary:

The TPA (Third-Party Administrator) Executive is responsible for managing all TPA-related activities in the hospital. This includes handling patient queries related to insurance, processing insurance claims, coordinating with insurance companies, and ensuring smooth and efficient TPA operations.

Key Responsibilities:

1. Patient Assistance:

- Assist patients with insurance and TPA-related queries.
- Guide patients through the insurance claim process.
- Verify patient insurance details and eligibility.

1. Insurance Claim Processing:

- Collect and verify all necessary documents for insurance claims.
- Process pre-authorization requests for cashless treatments.
- Submit insurance claims to TPA/insurance companies.
- Follow up on pending claims and coordinate with insurance companies for claim settlements.

1. Coordination and Communication:

- Liaise with various departments within the hospital to ensure all necessary documents and information are collected.
- Maintain effective communication with TPA/insurance companies.
- Update patients and their families on the status of their insurance claims.

1. Documentation and Record Keeping:

- Maintain accurate and up-to-date records of all insurance claims and related documents.
- Ensure proper filing and documentation of claim forms, pre-authorization requests, and other TPA-related paperwork.




- Prepare and submit regular reports on claim status and TPA activities to the TPA Manager/Hospital Administrator.

1. Compliance and Regulations:

- Ensure compliance with hospital policies and procedures, as well as regulatory requirements related to insurance and TPA services.
- Stay updated on changes in insurance policies and procedures.

1. Customer Service:

- Provide excellent customer service to patients and their families.
- Address and resolve any issues or concerns related to insurance claims promptly and professionally.

Qualifications and Skills:

- Education: Bachelor's degree in any discipline (a degree in healthcare management or related field is preferred).
- Experience: Minimum 2-3 years of experience in TPA/insurance services in a hospital or healthcare setting.

- Skills:
- Strong knowledge of health insurance policies and procedures.
- Excellent communication and interpersonal skills.
- Proficient in using hospital management software and Microsoft Office.
- Ability to work under pressure and handle multiple tasks simultaneously.
- Strong attention to detail and organizational skills.

Working Conditions:

- Work Environment: Hospital setting with frequent interaction with patients, their families, and hospital staff.
- Hours: Full time position, may require occasional evening or weekend work depending on hospital needs.

📌 TPA Executive (Pune)
🏢 Saathi Re NGO
📍 Pune