TPA Executive

Eye Q; Gurugram District; On-site; INR 300,000 - 520,000; Full time

Job summary

Eye-Q Eye Hospitals seeks a TPA Executive to manage third-party administrator processes, ensuring smooth claims, authorizations, and patient service.

You will verify policies, coordinate with insurers, process claims, maintain records, and support hospital staff to deliver seamless patient care through TPA services.

Experience in healthcare administration and familiarity with hospital information systems are preferred for this critical role.

Qualifications

• Background in healthcare administration or insurance processes.
• Experience with hospital information systems.
• Ability to handle multiple claims simultaneously and accurately.

Responsibilities

• Handle patient queries regarding insurance claims and TPA matters.
• Verify eligibility of health insurance policies for patients before treatment.
• Coordinate with insurance companies to obtain timely approvals.
• Process TPA claims and follow up on pending claims to ensure timely settlement.
• Maintain accurate records of all TPA-related transactions and documentation.
• Collaborate with hospital staff to ensure a seamless patient experience using TPA services.
• Assist in resolving discrepancies related to TPA claims.

Skills

Communication skills

Interpersonal skills

Problem solving

Attention to detail

CRM experience

Tools

Insurance claim software

Hospital management system

MS Office

CRM systems

Job description

Company Name: Eye-Q Eye Hospitals

Job Title: TPA Executive

Job Description: As a TPA Executive at Eye-Q Eye Hospitals, you will be responsible for managing the Third Party Administrator (TPA) processes to facilitate efficient claims processing and patient management. Your role will involve working closely with insurance companies, patients, and healthcare providers to ensure smooth operations and adherence to company policies. You will assist in the verification of health insurance policies, process claims, and address any issues that may arise in the TPA operations.

Key Responsibilities

• Handle patient queries regarding insurance claims and TPA-related matters.
• Verify eligibility of health insurance policies for patients before treatment.
• Coordinate with insurance companies to ensure timely approval for treatments.
• Process TPA claims and follow up on pending claims to ensure timely settlement.
• Maintain accurate records of all TPA-related transactions and documentation.
• Collaborate with hospital staff to ensure a seamless experience for patients using TPA services.
• Assist in resolving any issues or discrepancies related to TPA claims.

Skills Required

• Strong communication and interpersonal skills.
• Excellent problem-solving abilities.
• Attention to detail and organizational skills.
• Ability to work in a fast-paced environment.
• Proficiency in using computer applications and databases.

Tools Required

• Knowledge of insurance claim processing software.
• Familiarity with hospital management systems.
• Proficient in Microsoft Office Suite (Word, Excel, PowerPoint).
• Experience with customer relationship management (CRM) systems is a plus.

Join Eye-Q Eye Hospitals as a TPA Executive and contribute to providing quality healthcare services while ensuring efficient insurance processing for our patients.

Roles and Responsibilities

About the Role

As a TPA Executive at Eye-Q Eye Hospitals, you will be the primary liaison between the hospital and third-party administrators. Your role involves managing patient claims and ensuring smooth processing of insurance documents. You will work to resolve any issues related to insurance authorizations and facilitate timely patient admissions.

About the Team

You will be part of a dedicated TPA team that collaborates closely with various departments, including billing, patient services, and medical staff. The team values transparency, teamwork, and efficiency, ensuring that patients receive the best possible support during their insurance claim process.

You are Responsible for

• Managing the complete lifecycle of insurance claims, from pre-authorization to final settlement.
• Maintaining up-to-date knowledge of various insurance policies and procedures.
• Assisting patients with queries regarding their insurance coverage and claim status.
• Coordinating with the medical staff to gather necessary documentation for claims.
• Conducting regular follow-ups with insurance companies to expedite claim approvals.

To succeed in this role - you should have the following

• A background in healthcare administration or insurance processes
• Strong communication and interpersonal skills to effectively interact with patients and insurance representatives.
• Attention to detail and organizational skills to manage multiple claims simultaneously.
• Problem-solving abilities to address and resolve any discrepancies that may arise.
• Familiarity with hospital information systems and insurance software.