A TPA (Third-Party Administrator) Executive manages health insurance claims, pre-authorizations, and billing between patients, hospitals, and insurance companies. Key duties include verifying coverage, processing cashless/reimbursement claims, updating TPA portals, and ensuring timely claim settlements while providing customer service to patients.

Key Responsibilities

- Claim Processing: Handling cashless claim processes from admission to discharge, including preparing bills, updating implants, and reconciling accounts.
- Pre-Authorization: Obtaining and reviewing approvals for planned treatments and surgeries from insurance providers.
- Documentation & Portals: Maintaining accurate medical records, scanning documents, and managing TPA portals for updates.
- Coordination: Acting as the primary liaison between patients, hospital staff, and insurance companies for smooth service delivery.
- Patient Support: Advising patients on insurance benefits, coverage limits, and resolving queries regarding claims.





Required Skills and Qualifications

- Experience: 6 months to 5 years of experience in healthcare, specifically TPA/insurance billing, notes this Indeed search and Instahyre.
- Education: Bachelor’s degree in any discipline.
- Knowledge: Robust understanding of insurance policies, guidelines, and medical terminology.
- Technical Skills: Proficiency in TPA portals and hospital information systems (HIS).
- Communication: Excellent interpersonal skills to handle patient counseling and insurance coordination.

Job Types: Full-time, Permanent Pay: ₹15,000.00 - ₹25,000.00 per month

Benefits

- Paid sick time
- Paid time off
- Provident Fund

Ability to commute/relocate:
- Kalyan, Maharashtra: Reliably commute or planning to relocate before starting work (Required)

Experience:
- TPA AT HOSPITAL: 1 year (Required)

Work Location: In person

📌 TPA Executive (Kalyan)
🏢 Oasis Hospital
📍 Kalyan