<ul><li>Manage and coordinate health insurance claims and services between insurance companies and healthcare providers.</li><li>Verify and process insurance claims, ensuring they meet eligibility and policy requirements.</li><li>Liaise with insurance companies, healthcare providers, and policyholders to resolve claim-related issues.</li><li>Ensure timely and accurate submission of claims, ensuring compliance with insurance policies and regulations.</li><li>Maintain records of claims, approvals, denials, and payments for audit and compliance purposes.</li><li>Provide guidance to policyholders regarding their insurance coverage and claim status.</li><li>Resolve discrepancies and disputes in collaboration with the insurance company and healthcare providers.</li><li>Review medical bills and documents to determine the appropriateness of insurance coverage.</li><li>Prepare and present detailed reports to management on claim trends and resolution status.</li><li>Stay updated on insurance regulations, healthcare policies, and industry best practices.</li></ul>

TPA