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 skilled 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
- Accuracy in invoicing / billing Demonstrated ability to maintain confidentiality Service Excellence Active participation in all departmental training and development activities. Active participation in Inventory Management.
- Min 5 Years of relevant experience in TPA
- Must be Graduate .
