Cashless Executive – TPA Claim Process

Job Title: Cashless Executive

Department: TPA

Location: Ahmedabad

Experience Required: 25 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 (preferred: Commerce / Healthcare Administration)
• Certification in Hospital Management or Medical Billing (added advantage)
• Experience in TPA, hospital billing, medical coding, or claim processing is an added advantage.