Tpa Coordinator

Vitraya Technologies; New Delhi; On-site; INR 250,000 - 420,000; Full time

Benefits offered by this job

Food provided

Health insurance

Provident Fund

Job summary

Vitraya Technologies Private Limited in Delhi seeks a TPA Coordinator with strong medical knowledge to liaise between hospitals, TPAs, and insurers. Focus on pre-authorization and claims documentation while ensuring compliance with medical and policy guidelines.

Candidates with nursing, pharmacy, life sciences, or healthcare management backgrounds are invited, preferably with hospital TPA desk or insurer claims experience.

Qualifications

• Graduate in Nursing / Pharmacy / Life Sciences / Healthcare Management.
• Experience in hospital TPA desk or insurer claims team preferred.
• Strong medical knowledge and understanding of billing and claims processes.
• Ability to coordinate with hospitals and insurers and document medical details.

Responsibilities

• Coordinate with hospitals for pre-authorization and claim documentation
• Review and validate medical records and treatment details submitted by hospitals
• Ensure completeness and accuracy of claim files before submission
• Follow up with hospitals for pending medical or billing documents
• Support claim settlement by clarifying medical queries and policy conditions
• Maintain records of claims, approvals, denials, and escalations
• Assist in resolving claim-related issues between hospitals and insurers
• Ensure adherence to TPA and insurer SOPs

Skills

Medical terminology

Insurance claims knowledge

Clinical documents review

Communication skills

Computer skills

Education

Graduate in Nursing/Pharmacy/Life Sciences/Healthcare Management

Tools

Excel

Hospital portals

TPA systems

Job description

Hi,

We are Vitraya Technologies Private Limited, an IT product-based company specializing in delivering innovative software solutions to the insurance industry. Given our focus on the insurance sector, we require professionals with a medical background or a strong understanding of medical terminology and procedures.

We invite individuals who have completed medical-related courses such as Nursing BDS, MDS,FDS or an Insurance TPA Background, MBBS and are looking to transition from a clinical setting to a corporate environment.

Job Summary

We are seeking a TPA Coordinator with sound medical knowledge to act as a liaison between hospitals, TPAs, and insurers. The role focuses on managing pre-authorization and claims documentation while ensuring compliance with medical and policy guidelines.

Key Responsibilities

• Coordinate with hospitals for pre-authorization and claim documentation
• Review and validate medical records and treatment details submitted by hospitals
• Ensure completeness and accuracy of claim files before submission
• Follow up with hospitals for pending medical or billing documents
• Support claim settlement by clarifying medical queries and policy conditions
• Maintain records of claims, approvals, denials, and escalations
• Assist in resolving claim-related issues between hospitals and insurers
• Ensure adherence to TPA and insurer SOPs

Required Skills & Medical Knowledge

• Strong understanding of medical terminology, procedures, and hospital billing
• Knowledge of health insurance claims process and pre-authorization
• Ability to review clinical documents and discharge summaries
• Good coordination, follow-up, and communication skills
• Basic computer skills (Excel, hospital portals, TPA systems)

Educational Qualification

• Graduate in Nursing / Pharmacy / Life Sciences / Healthcare Management
• Experience working in hospital TPA desk or insurer claims team is preferred

Your role will be crucial in ensuring the integrity and accuracy of medical claims, contributing to a streamlined and efficient claims process for our clients.

Job Type: Full-time

Benefits:

• Food provided
• Health insurance
• Provident Fund

Work Location: In person

Job Type: Full-time

Benefits:

• Food provided
• Health insurance
• Provident Fund