TPA/Government Panel Executive

0 - 5 Years of Experience rupess outline icon

Not disclosed time outline icon

Full Time

Suvira Hospital, Jaipur

time outline icon Jaipur, Rajasthan, India

Posted on 18-03-2024

1233 Views

1 Vacancy

Description

Manage the end-to-end process of insurance claims administration, including claim intake, verification, adjudication, and payment processing, in accordance with company policies, regulatory requirements, and contractual agreements.
Serve as the primary point of contact for policyholders, healthcare providers, and government agencies regarding insurance claims inquiries, status updates, and dispute resolution, providing timely and accurate information and assistance.
Review and analyze insurance claims documents, medical records, policy information, and reimbursement calculations to ensure accuracy, completeness, and compliance with insurance policies, guidelines, and regulations.
Coordinate with healthcare providers to obtain additional information, documentation, or clarification as needed to process insurance claims, resolve claim discrepancies, and expedite claim adjudication and payment.
Collaborate with internal teams, including claims examiners, underwriters, customer service representatives, and IT support, to address claim-related issues, streamline workflows, and improve operational efficiency.
Maintain accurate records, documentation, and data related to insurance claims processing activities, ensuring confidentiality, integrity, and compliance with data protection regulations and company policies.
Stay updated with changes in insurance laws, regulations, and government panel guidelines, and ensure adherence to compliance requirements in insurance claims processing operations.
Prepare and generate reports, statistics, and analyses related to insurance claims processing performance, claim trends, turnaround times, and productivity metrics for management review and decision-making.