Dr. AGARWALS EYE HOSPITALS LTD

Name

DOJ DesignationTPA ExecutiveLocation Department

OperationsEmployee StatusTrainee / Probation / ConfirmedReporting To

Date Last Reviewed

Roles & Responsibilities:
Claims processing: Handle and process both cashless and reimbursement claims from hospitals and patients.
Document verification: Scrutinize medical documents, cross-check diagnoses with treatment details, and request necessary information from treating doctors or patients.
Pre-authorization: Send pre-authorization requests to insurance companies for cashless claims and obtain approvals.
Policy adherence: Review claims against policy terms and conditions to determine final adjudication decisions.
Stakeholder communication: Liaise with hospitals,



doctors, and insurance companies to ensure smooth operations and resolve queries.
Grievance handling: Effectively address and resolve grievances from policyholders.
Administrative support: Assist with general administrative tasks within the TPA department to ensure effective workflow.
Data entry and management: Maintain accurate records and files related to claims and policyholder information.
Responsibilities can be modified subject to necessity. Employee Signature Head Operations Head - HR

📌 Tpa Executive Mumbai Suburban
🏢 Dr Agarwals Eye Hospital
📍 Mumbai Suburban