TPA Executive

The TPA Executive will be responsible for handling insurance, cashless, pre-authorization, claim documentation, discharge approval, and claim follow-up activities in the hospital. This requires knowledge of TPA processes, insurance documentation, hospital billing coordination, patient communication, and portal handling. The candidate will ensure timely approvals, accurate claim documentation, smooth insured-patient support, and proper coordination with hospital teams.

Roles & Responsibilities

• Handle TPA, insurance, cashless, and reimbursement cases for hospital patients.
• Verify policy details, patient documents, eligibility, and required claim papers.
• Prepare and submit pre-authorization requests through TPA or insurance portals.
• Coordinate with patients, relatives, billing, doctors, nursing, admission, and discharge teams.
• Track approval status, queries, enhancements, discharge approval, and claim settlement.
• Maintain records of approved, pending, rejected, and closed insurance cases.
• Submit discharge summary, bills, investigation reports, and treatment documents on time.
• Respond to insurance company queries and coordinate required corrections.
• Guide patients regarding insurance process, required documents, shortfall, and approval status.
• Support billing team with package, estimate, final bill, and settlement coordination.
• Follow up for pending claims, delayed approvals, and insurance-related clarifications.
• Maintain confidentiality of patient and insurance-related information.
• Prepare daily TPA claim reports and pending case updates for seniors.
• Follow hospital SOPs, insurer guidelines, and documentation standards.
• Ensure smooth, accurate, and timely TPA support for patients and hospital operations.