Tpa Executive

Dr. AGARWALS EYE HOSPITALS LTD
JOB DESCRIPTION

Name
DOJ DesignationTPA ExecutiveLocation Department
OperationsEmployee StatusTrainee / Probation / ConfirmedReporting To
Date Last Reviewed
Roles & Responsibilities:

• Claims processing: Handle and process both cashless and reimbursement claims from hospitals and patients.
• Document verification: Scrutinize medical documents, cross-check diagnoses with treatment details, and request necessary information from treating doctors or patients.
• Pre-authorization: Send pre-authorization requests to insurance companies for cashless claims and obtain approvals.
• Policy adherence: Review claims against policy terms and conditions to determine final adjudication decisions.
• Stakeholder communication: Liaise with hospitals, doctors, and insurance companies to ensure smooth operations and resolve queries.
• Grievance handling: Effectively address and resolve grievances from policyholders.
• Administrative support: Assist with general administrative tasks within the TPA department to ensure efficient workflow.
• Data entry and management: Maintain accurate records and files related to claims and policyholder information.

* Responsibilities can be modified subject to necessity.

Employee Signature Head Operations Head - HR