Executive-TPA and Insurance

PeopleStrong; Thane; On-site; INR 300,000 - 500,000; Full time

Job summary

PeopleStrong in Thane is seeking an Executive- TPA & Insurance to ensure smooth processing of insurance and TPA activities including cashless approvals, claim documentation, billing coordination, and settlement follow-up, while supporting patients and maintaining compliance with hospital and insurance guidelines for efficient revenue realization.

Ideal candidate has 1–3 years of hospital TPA/insurance operations experience, graduation, familiarity with billing systems and HIS, and strong

Qualifications

• Graduate in any discipline (Healthcare Administration preferred).
• 1–3 years of experience in hospital TPA/insurance operations preferred.
• Familiarity with hospital billing systems and HIS preferred.

Responsibilities

• Coordinate with TPAs and insurance companies for cashless authorization and approvals.
• Verify patient insurance eligibility, policy coverage, and documentation requirements.
• Prepare, compile, and submit claim documents within defined timelines.
• Follow up on pending approvals, claim settlements, and reimbursement status.
• Ensure accuracy of billing, coding, and supporting medical documents.
• Address queries and discrepancies raised by TPAs/insurance companies.
• Maintain records of approvals, denials, settlements, and outstanding claims.
• Coordinate with clinical, billing, and front office teams for smooth claim processing.
• Ensure compliance with insurance protocols, NABH standards, and hospital policies.
• Generate MIS reports related to TPA claims, rejections, and revenue tracking.
• Support patients and attendants regarding insurance procedures and claim status.
• Escalate delayed or disputed claims to higher authorities when required.

Skills

Communication

Team work

Team Handling

Education

Graduation/Equivalent Course

Others

Tools

MS Office

HIS

Job description

Function Thane

Department TPA & Insurance

Cost Center TPA & Insurance

Country India

State Maharashtra

District Thane

Functional Area --

Skills

Skill

Communication Team work Team Handling

Graduation/Equivalent Course

Others

Working Language

Job Description

JOB PROFILE

Designation

Executive- TPA& Insurance

Grade

B04/EXEC/L2

Location

Thane

Department

Hospitality

Qualification

Graduate in any discipline (Healthcare Administration preferred).

Professional Experience

1–3 years of experience in hospital TPA/insurance operations preferred.

Familiarity with hospital billing systems and HIS preferred.

Role Purpose

To ensure smooth and timely processing of insurance and TPA-related activities including cashless approvals, claim documentation, billing coordination, and settlement follow-up, while supporting patients and maintaining compliance with hospital and insurance guidelines for efficient revenue realization..

Key Responsibilities

• Coordinate with TPAs and insurance companies for cashless authorization and approvals.
• Verify patient insurance eligibility, policy coverage, and documentation requirements.
• Prepare, compile, and submit claim documents within defined timelines.
• Follow up on pending approvals, claim settlements, and reimbursement status.
• Ensure accuracy of billing, coding, and supporting medical documents.
• Address queries and discrepancies raised by TPAs/insurance companies.
• Maintain records of approvals, denials, settlements, and outstanding claims.
• Coordinate with clinical, billing, and front office teams for smooth claim processing.
• Ensure compliance with insurance protocols, NABH standards, and hospital policies.
• Generate MIS reports related to TPA claims, rejections, and revenue tracking.
• Support patients and attendants regarding insurance procedures and claim status.
• Escalate delayed or disputed claims to higher authorities when required.
• Knowledge of TPA and health insurance processes.
• Good communication and coordination skills.
• Basic understanding of medical terminology and hospital billing.
• Proficiency in MS Office and Hospital Information Systems (HIS).
• Attention to detail and documentation accuracy.
• Ability to work under pressure and manage timelines.

Key Relationships

Key Relationships

• External: communicates with patients and their families.
• Internal: coordinates with Consultants, nurses, billing, Ward Coordinator, and OT.

Please Note: Job description is only a general guideline and will change depending on the organizational requirement.