Cashless Executive – TPA Claim Process - Ahmedabad - Nucleon Health

    Nucleon Health
    Nucleon Health Ahmedabad

    9 hours ago

    Healthcare
    Description

    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.

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