TPA Assistant Manager

• Decode and interpret corporate and personal health insurance policies.
• Check patient eligibility, coverage, exclusions, deductibles, co-pay and policy limits.
• Prepare and file pre-authorisation requests with TPAs/insurance companies.
• Coordinate with hospitals and insurance desks for required medical documents.
• Follow up and obtain initial/pre-authorisation approval.
• Prepare and submit documents for final approval/claim settlement.
• Handle queries, objections, deductions and clarification requests raised by TPAs/insurers.
• Strongly present and justify the medical necessity and admissibility of the case.
• Ensure maximum eligible claim value is captured as per policy terms and supporting documentation.
• Coordinate with hospitals, doctors, patients and insurance/TPA teams throughout the case.
• Track cases from admission/pre-auth through discharge and final approval.
• Maintain proper documentation and case records.
• Identify opportunities to reduce unnecessary deductions and improve claim realisation.
• Have good knowledge of surgical procedures, medical terminology and surgical billing.Role & responsibilities

Preferred candidate profile

Perks and benefits