Kailash Hospital & Heart Institute is looking for an experienced TPA Executive / Sr. Executive to handle insurance and TPA-related activities, ensuring smooth coordination between patients, insurance companies, TPAs and internal hospital departments.
Eligibility & Requirements
- Qualification: Graduate in any discipline.
- Experience: Relevant experience in Hospital TPA / Insurance Desk preferred.
- Good knowledge of cashless and reimbursement processes.
- Experience in handling pre-authorisation, approvals and claim documentation.
- Good understanding of insurance/TPA policies and procedures.
- Robust communication and coordination skills.
- Good knowledge of MS Office and hospital systems.
- Ability to handle patients and attendants professionally.
Key Responsibilities
- Handle cashless and reimbursement cases from admission to discharge.
- Process and follow up on pre-authorisation requests with TPAs/insurance companies.
- Coordinate with insurance companies and TPAs for timely approvals.
- Verify patient insurance documents and eligibility.
- Coordinate with doctors, billing, nursing and other departments for required medical documents.
- Ensure timely submission of claim-related documents.
- Follow up on pending approvals, queries and claim-related requirements.
- Handle TPA/insurance queries and resolve issues within the required timeline.
- Maintain proper records of cashless and reimbursement cases.
- Assist in reducing claim pendency and ensuring smooth discharge processes.
- Prepare required MIS/reports related to TPA and insurance cases.