TPA Executive Jobs

As a TPA Executive, you will play a crucial role in facilitating the smooth and efficient management of insurance claims. You will work closely with clients, healthcare providers, and insurance companies to ensure that all transactions and communications are handled effectively.**Key Responsibilities:**- **Claim Processing:** Review and process claim documents, ensuring all necessary paperwork is complete and compliant with insurance protocols.- **Client Coordination:** Communicate with clients to gather required information and updates regarding their claims, addressing any questions or concerns they may have.- **Provider Liaison:** Work with healthcare providers to verify patient eligibility and benefits, ensuring that services rendered are aligned with the insurance coverage.- **Documentation Management:** Maintain detailed records of claims processed, communications, and resolutions to ensure transparency and compliance with company standards.- **Problem Resolution:** Address and resolve any issues or discrepancies that arise during the claims process, collaborating with relevant parties to achieve satisfactory outcomes.**Required Skills and Expectations:**Candidates should have at least 2 to 4 years of experience in a similar role, demonstrating a strong understanding of the insurance claims process. A minimum education level of 12th pass is required. Excellent communication skills are essential for effective interaction with clients and providers. Proficiency in Microsoft Office, particularly Excel, is expected for managing documentation and data. Candidates should be detail-oriented, capable of handling multiple tasks efficiently, and possess strong problem-solving abilities to navigate challenges in the claims process. A professional attitude and the ability to work in a team are also important for success in this role.

Work on filling TPA application for cashless treatment . Need to coordinate with insurance company to fill the form and guide patient.Need to be in hospital in working hrs .Should be aware of the necessary mandatory documents which is required be insurance companies

Manage empanelment of hospitals with TPAs, insurance companies, corporates, and government schemes. Coordinate and ensure timely submission, follow-up, and closure of empanelment applications. Act as a single point of contact between client hospitals and external stakeholders (TPAs, insurers, regulators). Build and maintain strong client relationships, ensuring high satisfaction and retention. Track and update empanelment status, renewals, and compliance timelines. Support hospitals in meeting accreditation-related requirements for empanelment. Resolve client queries, escalations, and operational issues related to empanelment and accreditation. Maintain accurate documentation, MIS, and reporting for management review. Coordinate with internal quality, accreditation, and operations teams for smooth service delivery.Ensure compliance with regulatory, contractual, and confidentiality requirements.

TPA Executive Required Urgently in Palwal So Pl Call or Send Your Updated Resume Thanks

Job title: Hospital TPA Desk executive (Fresher)Job Location : JokaGender Preference: Male Stipend: 5k/ Monthly (For 3 months) After that salary will be increase as per candidates performance.Qualification: Hospital Management Pursuing / Pass out.(12.00pm 5.00pm)

Position: TPA/Health Insurance ExecutiveJob Location: Delhi, Mumbai, Kolakata, Hyderabad, Pune & ChennaiQualification : Any Medical graduation (BAMS / BUMS / BHMS / BDS)Experience: least 1 years' experience in Health Insurance / TPA /Insurance Brokerage.Skills: Excellent people management skills Ability to use technology to improve outcomes Good Excellent oral and written communication, negotiation and decision-making skills. Good customer service/relationship skills and ability to work effectively in a fast-paced environment with shifting priorities.Roles & Responsibilities: TPA/Empanelment. Manage & track cashless claims at hospital File upload and validation Maintain claims data and prepare reports Support patients with documentation assistance and clarify insurance queries. Prepare and maintain SOPs for claimsprocessing

Pre authorization requestsFinal ApprovalsSPOC between TPA & PatientsUndertakings & ConsentsTPA Recovery & RecordCoordination with Centre Incharge, Billing, Counselor, & OT.

ResponsibilitiesClaims Management:Coordinate with TPAs for pre-authorization, cashless treatment approvals, and claims processing.Verify documents and ensure accurate and timely submission of claims.Track claim statuses and follow up on pending or rejected claims.Patient Coordination:Guide patients on eligibility and processes for PMJAY and TPA-related services.Ensure beneficiaries under PMJAY receive entitled treatment and services.Address grievances related to insurance and scheme benefits.Data Management:Maintain accurate records of TPA claims and PMJAY patient data.Regularly update databases with approvals, discharges, and claims status.Liaison Work:Act as a bridge between the hospital, insurance companies, and government authorities.Communicate with TPAs for policy updates and process changes.Collaborate with the PMJAY nodal agency for compliance and reporting.Compliance and Reporting:Ensure adherence to government and TPA guidelines.Prepare and submit periodic reports on claims, reimbursements, and patient benefits.Ensure alignment with PMJAY and IRDAI (Insurance Regulatory and Development Authority of India) standards.Awareness and Training:Educate hospital staff and patients on TPA and PMJAY policies and benefits.Conduct workshops or sessions to improve understanding of processes among stakeholders.Skills and CompetenciesStrong understanding of health insurance policies, PMJAY guidelines, and claim processing.Excellent communication and negotiation skills.Proficiency in data management and healthcare software.Problem-solving and grievance-handling abilities.Knowledge of regulatory and compliance requirements.QualificationsBachelor's degree in any field (preferably in healthcare, business administration, or insurance).Knowledge or experience in health insurance, TPA, or government health schemes like PMJAY.Familiarity with hospital operations is a plus.Work EnvironmentWorking closely with hospital administrator

Should have Strong Knowledge in Aarogysri Documentation, Preauth and Claims.mou Renewalclaim Managementco Ordination with Government Authoritiesars End to End Procedure

We have vacant of 2 TPA Executive Jobs in Gurgaon,TPA Executive,Medical Officer,Health Insurance Counselor,Documentation Assistant, Experience Required : 1 Year Educational Qualification : Diploma, Professional Degree, B.Pharma, MBBS, M.Pharma, Other Doctorate Degree, Ph.D/Doctorate, DM/Doctorate of Medicine Skill TPA Executive,Medical Officer,Health Insurance Counselor,Documentation Assistant etc.Job location - Near MG Road Metro station, Gurgaon

We have vacant of 4 TPA Executive Jobs in Pimple Gurav, Experience Required : 2 Years Educational Qualification : Professional Degree,Other Bachelor Degree,B.A,B.Com Skill TPA , Billing Executive etc.

TPA Executive Required For Famous hospital in Tamil NaduLocation-1. Marthandam , Tamil NaduOther Details:-Salary - 12 - 15 kpm + IncentiveExperience : Fresher / Experienced AnyThe Interview Will Be Conducted Telephonic / VideoJob Role - Maintaining & uploading patient's files on the portal.Couriering the hard copy of patient's medical file to the Insurance companies. Good knowledge of TPA billing (Private / Corporate / Govt.) with ECHS, CGHS, Cashless RecoveriesHandle the team of Billing /Cashless TPA Executives with Following up with all the Insurance payer for payment or denials.Kindly Share In Your WhatsApp/ Facebook/Linkedin Etc Groups For HelpIf You Have Any Requirement For The Doctors Or Nurse For Your Hospital Or Center, Kindly Contact The Same Number.If You Don't Want To Receive Messages By Us, Kindly Reply No, We Will Never Message You AgainThanks & RegardsNamrataSenior RecruiterSpace Consultant

Send invoices and account updates to clientsKeep an accurate record of client accounts and outstanding balancesReceive, sort, and track incoming paymentsValidate debit accounts to ensure the credibility of paymentsIssue receipts for received paymentsAddress and solve client questions and issuesSecurely handle client data and payment informationProvide regular, accurate reports of billing data

We are hiring for hospital TPA executive who have experience in government pannel billing and private pannel billing.

Responsibilities:Develop and implement business development plans and strategies to attract and retain businesses in the region.Responsible for sustaining and growing the revenues with lead generation responsibilities.Laying down the roadmap for new account acquisition for the city and ensuring its execution.Strategizing and executing in coordination with other teams to develop new and better methods to drive client engagement.Candidates should have relevant experience in Business development and have a positive approach towards targets.Should be enthusiastic and smart to create a good impression in front of clients.Skills Required:Graduate/Post Graduate with 2-5 Years year work experience.Candidate must have experience in dealing with customers over phone and in personStart-up and Insurance exposure is preferred.Strong time management skills and the ability to prioritize to meet daily, weekly, and long-term requirements and goals.Structured problem solving and customer first attitude.Desire to network and align with the vision and mission of the organization

Accounting & Management-Setup of process & automation-Management of master fees files-Management & control of Fees booking entries in accounting software Tally-Controlling billing/invoicing across county-Arrangements of TPA Service Charge Reports-Coordination with all outstation offices-Fees Collection Follow-up for early release of payment-Resolving queries from Ins. Co. towards Fees -Resolving system issues at Ins. Co.-Lower TPA Fees Rate Confirmations & Follow-ups with Ins. Co. & inter departments-Liasoning with officials of Ins. Co. for early settlement of Fees & other queries-Reconciliation of Pending Fees in books of accounts-Fees MIS Management required by Ins. Co.-Audit Compliance of Ins. Co. -Compliance of internal & statutory auditors within our company.Apart from above mentioned routine work responsibilities, performing additional responsibilities:-MIS Reports Development for department-Net Banking setup for transactionsPresentation & Training

Complete Preauthorization ProcessTPA Discharge processTPA BillingTDS & discount calculationsClaim Settlements TPA Outstanding Recovery

Full job descriptionWe are looking for a TPA for Our Client company based in Australia in Gurgaon.(What Is a Third-Party Administrator (TPA)?A third-party administrator is a company that provides operational services such as claims processing and employee benefits management under contract to another company. Insurance companies and self-insured companies often outsource their claims processing to third parties.)Roles & ResponsibilitiesHandling TPA-related all processes from billing to coordinating with TPA companies.Check the medical admissibility of a claim by confirming the diagnosis and treatment details. Interpret the ICD coding, evaluate co-pay details, and classify non-medical expenses, room tariff, and capping...Assisting with all co-ordination activities from patient's admission to discharge.Follow up with Insurance companies to pass or clear the Health Insurance claims.REQUIREMENTSShould have good knowledge of all TPA work.Must be aware of the norms of the insurance sector.Basic Knowledge of billing.Required Exp from TPA , health insurance background, knows cost containment.International Classification of Diseases (ICD) Education Qualification: Doctor Degree Only in medical Job Type: Full-timeSalary: 35,000.00 - 70,000.00 per monthSchedule: Day shiftAbility to commute/relocate:Near Mg Metro Station, Gurgaon - 122001, HaryanaReliably commute or planning to relocate before starting work (Preferred)Experience:TPA: 4 year (Preferred)Note: Only immediate joiners can apply