- Cashless Pre-Authorization: Collect patient documents, fill out pre-auth forms, and submit requests to insurers/TPAs within strict turnaround times (TAT).
- Query Management: Coordinate with treating doctors, nurses, and billing departments to answer medical or financial queries raised by the TPA.
- Patient Communication: Update patients and relatives on approval, denial, or deduction statuses, and assist with reimbursement forms if a claim is rejected. [1]
- Discharge Coordination: Gather final itemized bills, discharge summaries, and lab reports to explicit the patient's file for final settlement.
- Tracking & Reporting: Maintain daily trackers for TPA patients, track outstanding bills, and follow up on payments.
At a TPA Firm or Insurance Company (Claims Specialist / Medical Officer)
- Claim Adjudication: Review cashless and reimbursement health insurance claims against policy terms, conditions, and treatment protocols.