TPA BAMS Doctor

Company: Jeena Sikho Lifecare Ltd.
Job Title: TPA Executive / Insurance Desk Executive
Department: TPA / Insurance Operations
Location: As per requirement
Employment Type: Full-Time
Working Days: 6 Days a Week
Salary Budget: 30,000 per month
Positions: 2

Job Summary

We are looking for TPA-trained non-medical professionals to manage insurance and TPA-related operational activities, including portal submissions, documentation, coordination with TPAs/insurance companies, and settlement reconciliation. The ideal candidate should have hands-on experience in hospital TPA/insurance desk operations.

Key Responsibilities

• Manage TPA/insurance portal submissions for pre-authorization and claims.
• Upload and submit required patient and claim-related documents on TPA/insurance portals.
• Track documentation and ensure all required documents are submitted within defined timelines.
• Coordinate with TPAs, insurance companies, hospital departments, and patients for claim-related requirements.
• Follow up on pending approvals, queries, deficiencies, and claim status.
• Maintain accurate records of submitted claims, approvals, rejections, queries, and settlements.
• Coordinate with the billing and accounts teams for claim settlement and reconciliation.
• Verify settlement statements against billed/approved amounts and identify discrepancies.
• Follow up with TPAs/insurers for pending payments and settlement issues.
• Maintain proper documentation for audits and future reference.
• Prepare daily/weekly/monthly TPA MIS reports as required.
• Ensure timely closure of pending TPA/insurance cases.
• Resolve documentation-related issues and coordinate with concerned departments.
• Maintain confidentiality of patient and insurance-related information.
• Ensure compliance with hospital and TPA/insurance processes and guidelines.

Required Qualification & Skills

• Graduate in any discipline; Hospital Administration / Healthcare Management qualification will be an added advantage.
• Prior experience in TPA/Insurance Desk operations is preferred.
• TPA-trained candidates will be preferred.
• Good knowledge of insurance claims, cashless processes, pre-authorization, and settlement procedures.
• Good working knowledge of MS Excel and hospital/TPA portals.
• Strong documentation and follow-up skills.
• Good communication and coordination skills.
• Strong attention to detail and accuracy.
• Ability to manage multiple claims and meet deadlines.

Preferred Experience

2+ years of relevant experience in hospital TPA/insurance desk, healthcare claims, insurance coordination, or settlement/reconciliation.