TPA Coordinator
0 - 5 Years of Experience
Not disclosed 
Full TimeRG Stone Urology & Laparoscopy Hospital, Dehradun
Dehradun, Uttarakhand, India
Posted on 22-03-2024
1 Vacancy
Description
- Comprehensive understanding of health insurance terminology, policies, procedures, and regulations.
- Familiarity with different types of insurance plans, including HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), and self-funded plans.
- Proficiency in managing TPA operations, including claims processing, eligibility verification, enrollment, and premium billing.
- Skill in navigating TPA software systems and databases to input and retrieve member information, process claims, and generate reports.
- Excellent interpersonal and communication skills to interact with clients, policyholders, healthcare providers, and internal stakeholders.
- Ability to address inquiries, concerns, and complaints in a professional, courteous, and timely manner, providing accurate information and assistance as needed.
- Experience in reviewing and adjudicating health insurance claims, verifying coverage, determining claim validity, and processing payments accurately and efficiently.
- Knowledge of claim denial reasons, appeals processes, and resolution strategies to assist members and providers in navigating claim disputes.
Category
Administration / Management
Key Skills
Insurance KnowledgeTPA OperationsCustomer ServiceClaims ManagementProblem-solving
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