Roles & Responsibilities:

 Actively contributes to the organization’s culture of excellence by participating in quality improvement, patient safety, and

accreditation initiatives, while engaging in continuous training to ensure sustained compliance with professional standards and

regulatory requirements.

 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 efficient workflow.

 Data entry and management: Maintain accurate records and files related to claims and policyholder information.

For more details you can Whatsapp on +91-XXXXXXXXXX

or you can Mail us your resume on [email protected]

Pay: ₹10,029.79 - ₹25,000.00 per month

Advantages:

- Flexible schedule
- Provident Fund

Work Location: In person

📌 TPA Executive (Wagholi)
🏢 Dr.Agarwal's Eye Hospital
📍 Wagholi