TPA Executive

About the job

Key Responsibilities

1. Patient Finance Processing

• Guide and counsel patients or their attendants regarding the available medical financing and loan options for their treatments.
• Collect all necessary finance-related documents (KYC, income proofs, bank statements, etc.) from the patients.
• Ensure all finance application forms are accurately filled out and immediately dispatched to the Head Office (HO) for loan processing and approval.2. Mediclaim & TPA Documentation
• Identify patients covered under medical insurance/TPA and explain the cashless or reimbursement processes to them.
• Collect all mandatory mediclaim documents, including insurance ID cards, government-issued IDs, pre-authorization forms, doctor's prescriptions, and diagnostic reports.
• Gather all post-treatment hospital documents, such as discharge summaries, final hospital bills, and payment receipts.
• Organize and submit the complete mediclaim dockets to the HO for claim processing.3. Query Resolution (Insurance & Finance)
• Monitor the status of pre-authorizations, final claim settlements, and finance approvals.
• Act as the primary point of contact for any queries raised by the TPA, Insurance Company, or Finance Partner.
• Coordinate directly with hospital staff (doctors, nurses, billing department) to gather the specific medical documents or justifications needed to resolve queries.
• Promptly submit all query-related documents to the HO to prevent delays in patient discharge or payment settlements.4. Record Keeping & Communication
• Maintain accurate digital and physical trackers of all documents sent to the HO.
• Keep patients and internal hospital departments updated on the status of their finance approvals and insurance claims.

Qualifications & Requirements

• Education: Bachelors degree in Commerce, Business Administration, Healthcare Management, or a related field.
• Experience: 1 to 3 years of experience in a hospital billing department, TPA desk, or medical insurance claims processing.
• Knowledge: Strong understanding of medical terminology, health insurance policies, TPA workflows, and basic personal finance/loan documentation.
• Tech Skills: Proficiency in MS Office (Word, Excel) and experience working with Hospital Information Systems (HIS).

Who can apply

Only those candidates can apply who