Executive - Claim Operations (Hospital TPA Desk)

Key Responsibilities (KRAs)

• Patient Counselling & Guidance: Counsel patients and their families regarding health

insurance coverage, co-pay clauses, non-payable items, pre-authorization procedures,

and overall claim process timelines to set clear expectations.

• Hospital TPA Helpdesk Management: Manage day-to-day operations at the dedicated

TPA / Health Insurance Helpdesk within partner hospitals.

• Cashless Claim Processing: Assist patients with pre-authorization paperwork, submit

initial requests, and coordinate cashless approvals with TPAs and insurance providers.

• Hospital Coordination: Work closely with hospital admission desks, billing departments,

and medical records teams to gather required discharge summaries, itemized bills, and

diagnostic reports.

• Query Resolution: Promptly address and resolve queries or deficiency letters raised by

TPAs/Insurers to prevent authorization or settlement delays.

• Documentation & Tracking: Maintain accurate daily tracking logs of patient admissions,

approvals, rejections, and pending query statuses.

Candidate Eligibility & Requirements

• Must-Have Experience: Direct experience working at a Hospital Helpdesk TPA or inside

a Hospital TPA/Insurance Desk is MANDATORY.

• Patient Counselling Skills: Proven ability to counsel patients empathetically, address

their concerns calmly, and explain complex insurance terms clearly.

• Experience Duration: Minimum 8 months to 1 year of hands-on experience in

healthcare claims or TPA operations.

• TPA Background: Prior experience working with top TPA companies or within hospital TPA cells.

• Domain Knowledge: Strong understanding of health insurance claim workflows, pre

authorization forms, medical terminology, and billing documentation requirements.

• Communication Skills: Clear verbal communication and strong interpersonal skills in

English and Kannada (Hindi is an added advantage) to interact comfortably with patients,

hospital administration, and insurance auditors.