Medical Officer TPA

PeopleStrong; Thane; On-site; INR 300,000 - 520,000; Full time

Job summary

PeopleStrong in Thane, India, seeks a role in the TPA & Insurance domain focused on cashless procedures and claim management. You will counsel patients, collect documents, submit preauthorisation, and coordinate with doctors, ward staff, and TPAs for approvals and final billing. Strong communication is essential.

Responsibilities include discharge coordination, post-claim query handling, and collaboration with billing and insurance desks to ensure smooth cashless processing.

Qualifications

• Clear communication skills and the ability to convey information effectively.
• Graduation or equivalent course completed.

Responsibilities

• Counselling patients and relatives for cashless procedures and policy eligibility.
• Collecting relevant documents for cashless, filling preauthorisation forms, and coordinating with doctors/ward staff.
• Coordinating with insurance vendors for approval letters and bill matching.
• Discharge coordination for final bill and discharge summary.
• Verifying cashless claim files prepared by TPA and responding to post-claim queries.

Skills

Clear Communication

Graduation/Equivalent Course

Others

Job description

Function Thane

Department TPA & Insurance

Cost Center TPA & Insurance

Country India

State Maharashtra

District Thane

Functional Area --

Skills

Skill

Communication Clear Communication

Graduation/Equivalent Course

Others

Working Language

Job Description

Key Responsibilities

• Counselling patients and relatives for cashless procedure, eligibility of class as per policy T&C. payment of non-medical expenses which not covered under policy.
• Collecting relevant documents for cashless, filling up of preauthorisation form, coordinating with treating doctor & ward RMO for getting relevant information for cashless procedure & query raised by the Insurance Co. / TPA.
• Coordinating with concerned Insurance Co. / TPA authority for getting approval letter, enhancement letter matching with total bill & updating Billing department about status of cashless sanctioned amount.
• Coordination with patient, Ward RMO, transcriptionist & billing department at the time of discharge for preparation of final bill & discharge summary.
• Verifying & scrutinising the cashless claim file prepared by TPA executive, answering the post claim queries raised by Insurance Co. / TPA.
• Coordinating with billing department for refund of security deposit paid by patient.
• Coordinating with investigator & arranging the relevant letter for cashless procedure.

Reply of post discharge query of cashless / reimbursement claim file.

Excellent verbal communication and the ability to convey information clearly and effectively.

Supplementary Position Guidelines

Key Relationships

• External: TPA officials, patients, insurance company representatives.
• Internal: Doctors, billing team, insurance desk, admin staff.

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