Tpa Manager

Rama Medicare; Dadri, Hapur, Baghpat; On-site; INR 300,000 - 500,000; Full time

Job summary

Rama Medicare in Dadri, Uttar Pradesh is seeking a TPA Claims Executive to help the team process health insurance claims end-to-end and resolve queries promptly. You will reconcile claims filed and received, verify policy terms, and coordinate for cashless claims with empanelled hospitals.

The role requires 1–4 years of experience in Pvt & Govt health claims, strong medical terminology knowledge, clear communication, and proficiency in MS Excel and claim management systems.

Qualifications

• Bachelor's degree in a relevant field.
• Experience of 1–4 years in health insurance claims (Pvt & Govt).
• Strong grasp of medical terminology, ICD codes and treatments.
• Clear verbal and written communication to handle disputes.
• Proficiency in MS Excel and insurance claim management systems.

Responsibilities

• Reconciliation: Review claim filed vs claim received.
• 0 Review claim status and reply to queries.
• 3 Verify policy terms, exclusions, errors and deductions.
• 4 Adjudicate: respond to queries and coordinate for cashless claims.
• 5 Coordinate with empanelled hospitals for billing updates.
• 6 Enter accurate claim details into the core CRM/TPA software.
• 7 Manage claims processing, adjudication, and settlement for health insurance policies.
• 8 Oversee data management, including ICD coding and CRM maintenance.
• 9 Ensure accurate AR/AP reconciliation.
• 10 Conduct audits to identify areas for financial improvement.
• 11 Verify patient eligibility and benefits before processing claims.

Skills

Health insurance claims

Medical terminology

Communication

Claims management

Education

Bachelor's degree

Tools

MS Excel

Insurance claim systems

Job description

Job Overview The TPA Claims Executive. To help team in filling error free health claim end to end & resolving query raised. To reconcile claim filed vs claim received. The goal is to ensure fast and accurate claim processing for hospital.

Key Responsibilities

• Reconciliation: Review Claim filled & claim received.
• Claim Assessment: Review Claim status & reply to query.
• Verification: Check policy terms, exclusions, Errors and deductions.
• Adjudication: Reply to query & coordinate for cashless claims.
• Hospital Coordination: Network with empanelled hospitals for billing updates.
• Data Management: Enter accurate claim details into the core CRM/TPA software.
• Manage claims processing, adjudication, and settlement for health insurance policies.
• Oversee data management, including ICD coding and CRM system maintenance.
• Ensure accurate billing and reconciliation of accounts receivable (AR) and payable (AP).
• Conduct audits to identify areas of improvement in financial management.
• Verify patient eligibility and benefits before processing claims.

Required Skills & Qualifications

• Education: Bachelors degree
• Experience: 1 to 4 years in health insurance for Pvt & Govt Claims.
• Medical Knowledge: Strong grasp of medical terminology, ICD codes, and treatments.
• Communication: Clear verbal and written skills to handle disputes.
• Tech Savvy: Proficiency in MS Excel and insurance claim management systems.