TPA Executive

Job Description We are looking for a detail-oriented TPA Executive to manage cashless insurance and reimbursement processes, coordinate with Third Party Administrators (TPAs), insurance companies, and the CGHS desk, and ensure timely claim processing while delivering a seamless patient experience. Key Responsibilities Process cashless hospitalization and reimbursement claims. Coordinate with TPAs, insurance companies, and CGHS authorities for pre-authorizations and claim approvals. Verify patient insurance eligibility, policy coverage, and required documentation. Prepare and submit pre-authorization requests, claim forms, and supporting medical documents. Follow up on pending approvals, claim settlements, and reimbursement cases. Coordinate with doctors, nursing, billing, medical records, and front office teams for claim related documentation. Ensure accurate documentation as per TPA, CGHS, and NABH guidelines. Resolve claim queries, discrepancies, deductions, and rejections within the stipulated timelines. Maintain records of claims, approvals, settlements, and pending cases. Ensure compliance with hospital policies, NABH standards, and insurance regulations. Assist patients in understanding insurance procedures and provide timely updates on claim status. Requirements Experience: 2–5 years of relevant experience in TPA operations, medical insurance