Job Description:

An Insurance/TPA Executive in an orthopedics hospital manages the financial clearance, scheme verification, and end-to-end claim documentation for patients undergoing treatments such as joint replacements, spine surgeries, trauma care, and rehabilitation. Because orthopaedic procedures often involve high-cost surgical packages and implants, this role is critical to ensuring smooth cashless approvals, preventing claim rejections, and maintaining hospital cash flow.

Key Responsibilities by Category1. TPA & Cashless Insurance Management (Retail/Corporate)

- Pre-Authorization Handling: Review doctor's advice and clinical notes, match orthopaedic diagnosis codes, and raise online pre-authorisation requests via insurance/TPA portals within strict Turnaround Times (TAT). Scribd
- Query Resolution: Actively track and respond to medical/financial queries raised by insurance companies (e.g., justification for specific implants, length of stay, or medical necessity of surgery) in coordination with orthopaedic surgeons. Scribd
- Discharge Management: Ensure final bills, discharge summaries, implant stickers/invoices, and investigation reports match the approved package to prevent severe deductions.

2. Government Scheme Administration (Ayushman Bharat, CGHS, ECHS)

- Beneficiary Verification: Verify patient eligibility and identity for schemes like Ayushman Bharat (PM-JAY), CGHS (Central Government Health Scheme), or ECHS (Ex-Servicemen Contributory Health Scheme) using dedicated government portals. ZeniaHR
- Package Compliance: Ensure all orthopaedic treatments, surgical consumables,



and implant usages strictly adhere to the designated CGHS/ECHS rate lists or Ayushman package caps.
- Portal Submission & Claims: Handle blocking of funds, pre-auth submissions, and final claim documentation on respective state/central scheme portals (e.g., NHA portal for PM-JAY). ZeniaHR

Education & Qualifications

- Degree: Bachelor’s degree in Commerce (B.Com), Business Administration (BBA), Hospital Administration (BHA), or Science (B.Sc).
- Experience: 1 to 3 years of experience working in a hospital insurance, billing, or TPA desk setting.
- Specialized Knowledge: Hands-on familiarity with handling health insurance portals, corporate TPA desks, and government healthcare schemes (Ayushman/CGHS/ECHS). ZeniaHR

Essential Skills

- Portal & Technical Proficiency: Expert navigation of major TPA portals and government health scheme dashboards, alongside proficiency in Hospital Information Systems (HIS) and MS Excel. ZeniaHR
- Understanding of Orthopaedic Terminology: Basic comprehension of orthopaedic procedures, terms (e.g., arthroplasty, fixation, implants), and itemized billing structures.
- Negotiation & Attention to Detail: High precision in verifying package inclusions/exclusions to prevent claim deductions, short-payments, or rejections.
- Communication & Crisis Management: Ability to coordinate calmly and efficiently between anxious patients, doctors, and external insurance agents under strict time constraints.

Pay: ₹10,000.00 - ₹33,000.00 per month

Benefits:

- Paid sick time
- Paid time off
- Provident Fund

Work Location: In person

📌 Insurance Executive (Patna)
🏢 Ashish Joint Replacement Care
📍 Patna