Walk-in | TPA Executive - Max Patparganj

Max Healthcare; New Delhi; On-site; INR 350,000 - 550,000; Full time

Job summary

Max Healthcare in Delhi is seeking a candidate to manage TPA processing for cashless and post-discharge health insurance claims. You will ensure timely entry, respond to TPA queries, and follow up on preauthorisations with insurers.

The role involves medical scrutiny, claim adjudication, and adherence to NABH-compliant SOPs. The ideal candidate should have a minimum of 2 years of experience in TPA, preferably in a hospital setting, and must be a graduate.

Qualifications

• Min 2 Years of relevant experience in TPA only.
• Hospital TPA experience preferred.
• Must be Graduate.

Responsibilities

• Maintain TPA processing of cashless and post-discharge health insurance claims.
• Maintain overall TAT entry to exit.
• TPA query reply and preauthorisation follow-up with insurance company/TPA.
• Medical scrutiny and medical opinion for health insurance claims.
• Efficient in claim adjudication and processing.
• Maintain SOPs and protocols.
• Keep records for all correspondence with TPA.
• Post-discharge reconciliation for utilization of claims.
• Timely reply to internal TPA complaint portal.
• TPA discharge follow-up and closure.
• Maintain departmental records per NABH requirements.
• Utilize hospital information system, MIS generation of TPA patients.
• Demonstrate proactive cooperation and team-oriented approach.

Skills

TPA processing

Medical claims

Customer focus

Education

Graduate

Job description

Role & responsibilities

• To be responsible for maintaining TPA Processing of cashless and all post discharge health insurance claims.
• To be responsible to maintain overall TAT entry to exit.
• TPA query reply and preauthorisation follow up with insurance company / tpa.
• Medical scrutiny and medical opinion for health insurance claims.
• Efficient in claim adjudication and claim processing.
• Maintaining and ensuring Standard Operating Procedures and protocols.
• To be responsible for keeping record for all correspondence done for TPA.
• Post discharge reconciliation for utilization of claims.
• Timely reply to internal TPA complaint portal.
• TPA discharge follow up and closure.
• Mmaintenance of departmental records as per the NABH requirement.
• Effective utilization of hospital information system, MIS generation of TPA patients.
• To display proactive cooperation and contribute to cordial inter and intra team relations, solution orientation and team solidarity. Should be cost effective.
• To participate in training programs to maintain and update your professional knowledge.
• To achieve high levels of customer satisfaction at each interaction.
• Any task assigned to you by your HOD from time to time.

Preferred candidate profile

• Min 2 Years of relevant experience in TPA only
• Hospital TPA experience preferred
• Must be Graduate