TPA Executive

Thind Eye Hospital is seeking a TPA Executive to manage cashless, insurance, corporate and government-panel cases accurately and within prescribed timelines. The executive will verify patient eligibility, policy or beneficiary details, empanelment conditions, package rates and required approvals before admission or procedure. Responsibilities include collecting and checking identity documents, cards, prescriptions, investigation reports, estimates, consent records and other supporting documents; preparing and submitting pre-authorisation requests; tracking approvals; and communicating status clearly to patients and internal teams. The candidate will coordinate with doctors, counsellors, billing, OT, pharmacy, accounts and medical-records staff to ensure that clinical and financial documents are complete and consistent. After treatment, they will compile final claims, upload documents on insurer or TPA portals, respond to queries and deficiencies, track deductions and denials and support reconciliation and payment follow-up. The executive must maintain payer-wise files, approval registers, claim trackers, outstanding statements and periodic MIS. They should remain updated on package terms, exclusions, tariffs, documentation requirements and hospital empanelments and escalate any conflict before commitment to the patient. Accuracy, confidentiality and prevention of duplicate, unsupported or non-compliant claims are essential. Candidates should have strong computer skills, familiarity with email and online portals and clear written communication. Knowledge of CGHS, ECHS, PSU, private insurance or other institutional schemes will be an advantage. The ideal candidate is methodical, deadline-oriented and capable of working with multiple stakeholders while protecting both patient convenience and the hospitals financial and regulatory interests.