TPA Executive

Process cashless and reimbursement claims with accurate verification of policy coverage, treatment details, and medical documentation.

Manage pre-authorization requests, obtain approvals, and respond to insurer/TPA queries within defined timelines.

Coordinate with insurance companies, TPAs, medical records (MRD), billing, and clinical teams to ensure seamless claim processing.

Validate ICD/CPT coding accuracy, billing breakups, discharge summaries, and treatment justifications as per insurance standards.

Track claim status through TPA portals and hospital HIS, update records, and escalate delays or discrepancies.

Handle denials, short settlements, and claim audits, ensuring compliance with hospital policies and insurance guidelines.

Assist patients with eligibility checks, approval updates, claim requirements, and related insurance queries.

Maintain documentation for internal audits, insurance audits, and compliance checks while ensuring data accuracy and confidentiality.

• Experience

  1 - 3 Years

• No. of Openings

  2

• Education

  Graduate

• Role

  TPA Executive

• Industry Type

  Hospitals / Medical / Healthcare Equipments

• Gender

  [ Male / Female ]

• Job Country

  India

• Type of Job

  Full Time

• Work Location Type

  Work from Office

• Face interview location

  behind NEELKANTH PALMS, Nalpada, Kapurbawdi, Thane West, Thane, Maharashtra 400601