TPA Executive

Drlogy; Ahmedabad District; On-site; INR 300,000 - 400,000; Full time

Job summary

Drlogy is seeking a TPA Executive to manage insurance and patient coordination at Health1 Hospital in Ahmedabad. This role involves handling pre-authorization, claim documentation, and communication with insurance providers and patients.

Candidates should have a graduate degree, 1–2 years of relevant experience, and strong knowledge of hospital insurance processes. The position ensures timely and accurate service support in insurance matters.

Qualifications

• 1–2 years of experience in insurance management.
• Proficiency in handling claim documentation.
• Ability to coordinate with multiple stakeholders effectively.

Responsibilities

• Manage TPA and insurance coordination for patients.
• Prepare and submit necessary authorization forms and medical documents.
• Coordinate with various departments to ensure smooth processes.

Skills

Communication skills

Knowledge of hospital insurance processes

Documentation accuracy

Coordination

Education

Any graduate qualification

Job description

The TPA Executive will be responsible for managing insurance, cashless, corporate, pre-authorization, claim documentation, discharge approval, and TPA coordination at Health1 Hospital, Ahmedabad. This requires any graduate qualification, 1–2 years of experience, knowledge of hospital insurance processes, documentation accuracy, communication skills, and coordination with billing, doctors, MRD, patients, and insurance providers.

• Manage TPA, insurance, corporate, and cashless patient coordination.
• Verify insurance policy details, patient documents, proof, and eligibility requirements.
• Prepare and submit pre-authorization forms, medical documents, and claim papers.
• Coordinate with doctors, billing, MRD, nursing, patients, and insurance companies.
• Track approvals, enhancements, queries, denials, final approvals, and discharge clearance.
• Explain insurance process, documents, approvals, and patient responsibility clearly to attendants.
• Maintain TPA files, claim records, approval letters, query responses, and daily trackers.
• Support discharge billing by coordinating final authorization and insurance clearance.
• Follow up with TPA companies for pending approvals and claim status updates.
• Ensure accuracy in diagnosis details, treatment notes, package information, and billing documents.
• Escalate rejected, delayed, or disputed claims to seniors promptly.
• Maintain confidentiality of patient, insurance, and financial information.
• Prepare MIS reports related to cashless cases, pending claims, and approvals.
• Follow hospital TPA SOPs, documentation standards, and compliance requirements.
• Ensure smooth, timely, and patient-friendly insurance service support.