Job Description

Job Summary:

The Claims/TPA Executive will be responsible for managing the end-to-end process of insurance claims and Third-Party Administrator (TPA) coordination within the hospital. This role ensures accurate billing, timely claim submission, and smooth settlement of insurance cases while maintaining compliance with hospital policies and insurance guidelines.

Key Responsibilities:

Insurance & TPA Coordination

Liaise with TPAs and insurance companies for pre-authorization, approvals, and claim settlement. Ensure proper documentation for cashless and reimbursement cases. Prepare and verify patient bills as per insurance guidelines.

Billing & Claims Processing

Submit claims accurately and within stipulated timelines. Track claim status and follow up for pending approvals or payments

Documentation & Compliance

Maintain patient insurance records and ensure completeness of documents. Adhere to hospital SOPs and regulatory requirements for insurance claims.

Patient Interaction

Assist patients and attendants in understanding insurance coverage and claim process. Resolve queries related to billing and insurance

Reporting & MIS

Generate daily/weekly/monthly reports on claim status, approvals, and settlements. Highlight discrepancies and escalate unresolved issues to management.

Required Skills & Competencies:

Strong knowledge of health insurance policies and TPA processes. Familiarity with hospital billing systems and software. Excellent communication and negotiation skills. Attention to detail and ability to work under pressure.

Qualifications and Experience:

Minimum Graduate Minimum 1-2 years of experience in hospital billing and insurance claims.

Key Performance Indicators (KPIs):

Timely submission and settlement of claims. Accuracy in billing and documentation. Patient satisfaction in insurance handling.
Job Type: Full-time

Pay: ₹200,000.00 - ₹300,000.00 per year

Work Location: In person