. Job Summary The TPA (PM-JAY) Executive is responsible for managing Ayushman Bharat – Pradhan Mantri Jan Arogya Yojana (PM-JAY) patient documentation, beneficiary verification, pre-authorisation, claim submission, and coordination with doctors, billing, and medical records departments to ensure smooth cashless treatment for eligible patients.

- Key Responsibilities

- Verify Ayushman card details, patient identity, and scheme eligibility.
- Register eligible patients and process cases through the authorized PM-JAY portal.
- Collect and verify the required patient documents and medical records.
- Coordinate with treating doctors to obtain clinical notes, investigation reports, and treatment plans.
- Submit pre-authorisation requests according to the applicable scheme guidelines.
- Monitor approval status and follow up on pending pre-authorisation requests and queries.
- Ensure treatment and billing are processed according to the approved package and applicable scheme rules.
- Collect discharge summaries, investigation reports, operative notes, and other required claim documents.




- Submit claims within the prescribed timelines and monitor claim status.
- Follow up on rejected, queried, or pending claims and coordinate corrective action.
- Maintain accurate records of patient cases, approvals, claims, and payments.
- Coordinate with the billing department, doctors, nursing staff, medical records department, and hospital administration.
- Assist during internal and external audits related to PM-JAY cases.
- Ensure compliance with PM-JAY guidelines and hospital policies.

3. Eligibility Criteria
- Graduate in any discipline; healthcare administration or hospital management qualifications preferred.
- Experience in hospital TPA, Ayushman Bharat, insurance desk, or medical billing preferred.
- Knowledge of patient documentation, claim processing, and basic computer applications.
- Good communication, coordination, and record-management skills.

Pay: ₹10,000.00 - ₹20,000.00 per month

Advantages

- Health insurance
- Provident Fund

Work Location: In person

📌 TPA Executive (Darbhanga)
🏢 DDD Recuriting
📍 Darbhanga