TPA Executive
2 - 5 Years of Experience
Not disclosed 
Full TimeCARE CHL Hospitals, Indore
Indore, Madhya Pradesh, India
Posted on 15-04-2024
818 Views
4 Vacancies
Description
- Reviewing and processing healthcare insurance claims submitted by policyholders or healthcare providers.
- Verifying claim details, including patient information, treatment codes, and billing documentation.
- Adjudicating claims based on policy coverage, contractual agreements, and regulatory guidelines.
- Resolving claim disputes, appeals, and inquiries in a timely and accurate manner.
- Assisting with policy enrollment, renewal, and maintenance activities for individual and group insurance plans.
- Updating policyholder information, coverage details, and beneficiary designations in the TPA system.
- Providing guidance and support to policyholders regarding plan options, benefits, and eligibility criteria.
- Serving as a primary point of contact for policyholders, healthcare providers, and insurance company representatives.
- Responding to inquiries, requests, and concerns regarding claims status, coverage, and reimbursement.
- Communicating proactively with stakeholders to provide updates, resolve issues, and ensure transparency throughout the claims process.
Category
Administration / Management
Preferred Education
MCom (Master of Commerce)BCom (Bachelor Of Commerce)MBA Finance
Key Skills
Claims Processing and AdjudicationPolicy Administration and EnrollmentCustomer Service and CommunicationData Management and ReportingRegulatory Compliance
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