Job Description

Position:

TPA Executive

Location:

Sunrise Hospital, Kalindi Colony

Department:

Billing & Insurance

Reporting To:

Billing/TPA Manager or Hospital Administrator

Job Objective:

To ensure smooth coordination and processing of TPA (Third Party Administrator) and insurance-related documentation for patient admissions, approvals, and discharges, ensuring proper billing and timely reimbursements.

Key Responsibilities:

TPA & Insurance Coordination:

Handle pre-authorization requests and approvals from insurance companies and TPAs. Coordinate with patients, doctors, and TPA representatives for required documentation. Maintain accurate and updated records for all TPA/insurance patients.

Billing Support:

Ensure timely submission of medical bills to insurance companies. Cross-check the bills and ensure they comply with insurance norms and packages. Reconcile claims with approvals and ensure minimal deductions or rejections.

Admission & Discharge Support:

Facilitate the admission and discharge processes for TPA/insured patients. Prepare final bills in coordination with billing and medical departments. Ensure timely communication with TPA coordinators for discharge approvals.

Documentation & Follow-up:

Maintain complete files with all supporting documents like ID, policy copy, pre-auth forms, discharge summary, etc. Track pending claims and follow up for timely settlements. Coordinate with internal departments to resolve billing queries or discrepancies.

Customer Support:

Address patient queries related to TPA/insurance processing. Provide assistance in filling forms and understanding policies.

Reporting:

Generate daily/monthly reports on TPA/insurance billing and settlement status. Escalate unresolved or high-pending cases to management.

Key Skills Required:

Knowledge of insurance procedures, TPA coordination Good communication and interpersonal skills Proficiency in MS Office & Hospital Information Systems (HIS) Attention to detail and documentation Time management and ability to work under pressure

Qualification & Experience:

Graduate in any stream (Commerce/Healthcare preferred) Minimum 1-3 years of experience in hospital TPA/insurance desk
Job Types: Full-time, Permanent

Pay: ?15,000.00 - ?35,000.00 per month

Benefits:

Cell phone reimbursement Paid sick time Provident Fund
Schedule:

Rotational shift
Supplemental Pay:

Commission pay Performance bonus Yearly bonus
Experience:

TPA Executive: 2 years (Required)
Location:

Maharani Bagh, Delhi, Delhi (Required)
Work Location: In person

Application Deadline: 16/06/2025