TPA Coordinator

Role Overview

The TPA Coordinator will be responsible for managing the end-to-end insurance and third-party administrator (TPA) processes for patients. This role requires handling pre-authorization requests, verifying insurance documentation, and ensuring timely approvals to facilitate cashless treatment for patients.

Key Responsibilities

• Manage pre-authorization procedures by verifying insurance documents and securing cashless approvals in a timely manner from insurance companies and TPAs.
• Accurately prepare, review, and submit medical bills, discharge summaries, and claim documents to insurance providers within established deadlines.
• Provide clear guidance to patients and their families on insurance procedures, including explaining cashless treatment workflows, coverage limits, and necessary paperwork.
• Upload patient medical records onto online TPA systems and send physical copies to relevant insurance offices via courier.
• Monitor and track pending and outstanding claims daily, collaborating with insurance adjusters to address queries or resolve billing inconsistencies and expedite payments.
• Liaise with hospital finance and accounts teams to reconcile payments, track outstanding receivables, and compile daily or monthly management information system (MIS) reports.
• Ensure all operational processes comply with hospital policies, insurance regulations, and legal requirements during both internal and external audit procedures.

Additional Information

This position is located in Chandigarh and offers a monthly salary range of 18,000 to 25,000 INR.