Job Description

Job Summary: Manage TPA (Third Party Administrator) operations, ensuring efficient processing of health claims. Coordinate with healthcare providers, insurers, and customers to resolve claim-related issues. Analyze data to identify trends and areas for improvement in the claims process.
Responsibilities

Coordinate with healthcare providers, insurance companies, and patients to resolve claims-related issues. Process patient claims from admission to discharge, ensuring accurate and timely payment. Manage TPA (Third Party Administrator) activities, including claim settlements and reconciliations. Maintain CRM (Customer Relationship Management) software to track customer interactions and updates. Ensure compliance with regulatory requirements for medical insurance policies. Handling TPA related all process from billing to co-ordinate with TPA companies. Responsible for counselling patient's family & pre-Auth process. Maintaining & uploading patient's files on the portal. Couriering the hard copy of patient's medical file to the Insurance companies. Responsible for all co-ordination activities from patient's admission to discharge. Handling billing Department, Implants bill updating & reconciliation. Daily co-ordination with the patient and Hospital staff. Preparing split bills/ Doctor charges etc. Handling all TPA Portals. Outstanding follow-up with TPA. Monthly Review report. To obtain and review referrals and authorizations for treatments. To follow and adhere to all regulations and guidelines set by state programs, and HMO/PPO, etc. Must be aware of norms of the insurance sector. Daily follow up with Insurance companies to pass or clear the Health Insurance claims.
Job Types: Full-time, Permanent, Fresher

Pay: ₹20,127.64 - ₹27,681.51 per month

Benefits:

Leave encashment Provident Fund
Education:

Bachelor's (Preferred)
Work Location: In person