Tpa Executive

Dr Agarwals Eye Hospital; Mumbai Suburban; Sur place; INR 400 000 - 520 000; Plein temps

Résumé du poste

Dr AGARWALS EYE HOSPITALS LTD invites applications for a TPA Executive in Mumbai Suburban. The role involves handling cashless and reimbursement claims, verifying documents, obtaining pre-authorizations, and ensuring compliance with policy terms.

The position requires strong data entry and administrative skills, with responsibilities across stakeholder communication and grievance resolution within the TPA department.

Responsabilités

• Claims processing: Handle and process both cashless and reimbursement claims from hospitals and patients.
• Document verification: Scrutinize medical documents, cross-check diagnoses with treatment details, and request necessary information from treating doctors or patients.
• Pre-authorization: Send pre-authorization requests to insurance companies for cashless claims and obtain approvals.
• Policy adherence: Review claims against policy terms and conditions to determine final adjudication decisions.
• Stakeholder communication: Liaise with hospitals, doctors, and insurance companies to ensure smooth operations and resolve queries.
• Grievance handling: Address and resolve grievances from policyholders.
• Administrative support: Assist with general administrative tasks within the TPA department to ensure efficient workflow.
• Data entry and management: Maintain accurate records and files related to claims and policyholder information.

Description du poste

Dr. AGARWALS EYE HOSPITALS LTD

JOB DESCRIPTION

Name

DOJ DesignationTPA ExecutiveLocation Department

OperationsEmployee StatusTrainee / Probation / ConfirmedReporting To

Date Last Reviewed

Roles & Responsibilities:

• Claims processing: Handle and process both cashless and reimbursement claims from hospitals and patients.
• Document verification: Scrutinize medical documents, cross-check diagnoses with treatment details, and request necessary information from treating doctors or patients.
• Pre-authorization: Send pre-authorization requests to insurance companies for cashless claims and obtain approvals.
• Policy adherence: Review claims against policy terms and conditions to determine final adjudication decisions.
• Stakeholder communication: Liaise with hospitals, doctors, and insurance companies to ensure smooth operations and resolve queries.
• Grievance handling: Effectively address and resolve grievances from policyholders.
• Administrative support: Assist with general administrative tasks within the TPA department to ensure efficient workflow.
• Data entry and management: Maintain accurate records and files related to claims and policyholder information.

* Responsibilities can be modified subject to necessity.

Employee Signature Head Operations Head - HR