Job Description

1.

TPA & Insurance Coordination

Act as the primary liaison between the hospital and all empaneled TPAs and insurance companies. Ensure all documentation required for cashless and reimbursement claims is complete and submitted on time.
2.

Cashless Authorization

Facilitate the process of obtaining pre-authorization approvals for cashless treatments. Monitor turnaround time for approval and escalate delays as necessary. Coordinate with doctors and departments for timely medical information required by TPAs.
3.

Claims Processing & Documentation

Oversee preparation and submission of final bills and discharge summaries to TPAs. Ensure all claims are submitted accurately with complete supporting documents. Monitor the status of submitted claims and follow up regularly until settlement.
4.

Reimbursement Follow-ups

Track claim rejections or short payments. Reconcile accounts and resubmit or appeal denied claims with justifications. Maintain communication with patients about the status of their insurance claims.
5.

Empanelment & TPA Agreements

Manage TPA empanelment processes and documentation. Review and renew contracts with TPAs and insurance companies as needed.
6.

MIS & Reporting

Maintain updated records of all cashless and reimbursement claims. Generate daily/weekly/monthly reports on claim status, approvals, rejections, and payments received. Analyze data to identify bottlenecks or trends in claim rejections.
7.

Team Management

Supervise and train the TPA desk staff. Allocate duties, monitor performance, and ensure quality service.
8.

Patient Support & Counselling

Educate patients about their insurance policies, entitlements, and the claim process. Assist patients in completing necessary paperwork. Address grievances related to delays or denials of claims.
9.

Compliance & Audit

Ensure compliance with IRDAI guidelines and other regulatory requirements. Prepare for audits by TPAs or insurance companies and respond to audit queries.
10.

Coordination with Internal Departments

Work closely with billing, admission, discharge, and medical records departments. Ensure seamless flow of information for cashless and reimbursement processing.
Job Type: Full-time

Pay: ₹20,000.00 - ₹50,000.00 per month

Benefits:

Cell phone reimbursement Paid sick time Provident Fund
Work Location: In person