TPA Claims Coordinator

TPA Claims Coordinator – Job Description

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• Handle end-to-end coordination of cashless and reimbursement claims with TPAs and insurance companies.
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• Understand cashless claim processing, including documentation, pre-authorization, and follow-up for approvals.
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• Manage reimbursement claim procedures: collecting bills, discharge summaries, and ensuring timely submission.
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• Maintain knowledge of mediclaim policies and empanelment processes across various insurance providers.
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• Coordinate with patients, hospital billing departments, and TPAs to ensure smooth claim settlements.
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• Ensure timely updates and communication with patients and families regarding claim status.
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• Keep accurate records of claims submitted, approvals, queries, and final settlements.
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• Liaise with HR or admin teams for corporate empanelments and insurance tie-ups.
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• Stay updated with changes in insurance guidelines, policies, and regulatory norms.
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• Provide support in audits and reports related to TPA claims and insurance billing.