Cashless Executive – TPA Claim Process

Job Title:

Cashless Executive
Department:  TPA

Location:

Ahmedabad
Experience

Required:

2–5 years (TPA/Healthcare Industry preferred)

Job Summary
The Cashless Executive is responsible for handling cashless hospitalization processes, coordinating with TPAs and insurance companies, processing pre-authorizations, and ensuring timely approvals and settlements while maintaining accuracy and compliance with hospital and insurer guidelines.

Key Responsibilities
Coordinate with patients, doctors, and billing departments for cashless admission procedures
Process and submit pre-authorization requests to TPAs/Insurance companies
Follow up for approvals, queries, and enhancements from TPAs/Insurers
Verify patient insurance details, policy coverage, and eligibility
Maintain accurate documentation for cashless cases
Handle denials, rejections, and justifications with supporting medical records
Assist in final bill preparation and submission for cashless settlements
Track pending approvals and settlements to ensure timely closure
Ensure compliance with hospital policies and insurer guidelines
Maintain proper records and MIS reports for management
Coordinate with finance and accounts teams for reconciliation
Handle patient and attendant queries related to cashless insurance

Key Skills Required
Good knowledge of TPA and health insurance processes
Familiarity with pre-authorization and claim settlement procedures
Strong communication and coordination skills
Attention to detail and documentation accuracy
Ability to handle pressure and multiple cases simultaneously
Basic computer knowledge (MS Excel, Hospital Information System)

Qualifications
Graduate in any discipline
Experience in TPA, hospital billing, medical coding, or claim processing is an added advantage.