Executive

About the Role

Executive - Claim Operations (Hospital TPA Desk) at MedsCred.

Key Responsibilities

• Patient Counselling & Guidance: Counsel patients and their families regarding health insurance coverage, co-pay clauses, non-payable items, pre-authorization procedures, and overall claim process timelines.
• Hospital TPA Helpdesk Management: Manage day-to-day operations at the dedicated TPA / Health Insurance Helpdesk within partner hospitals.
• Cashless Claim Processing: Assist patients with pre-authorization paperwork, submit initial requests, and coordinate cashless approvals with TPAs and insurance providers.
• Hospital Coordination: Work closely with hospital admission desks, billing departments, and medical records teams to gather required discharge summaries, itemized bills, and diagnostic reports.
• Query Resolution: Promptly address and resolve queries or deficiency letters raised by TPAs/Insurers.
• Documentation & Tracking: Maintain accurate daily tracking logs of patient admissions, approvals, rejections, and pending query statuses.

Requirements & Tech Stack

• Must-Have Experience: Direct experience working at a Hospital Helpdesk TPA or inside a Hospital TPA/Insurance Desk is MANDATORY.
• Patient Counselling Skills: Proven ability to counsel patients empathetically, address concerns calmly, and explain complex insurance terms clearly.
• TPA Background: Prior experience working with top TPA companies or within hospital TPA cells.
• Domain Knowledge: Strong understanding of health insurance claim workflows, pre authorization forms, medical terminology, and billing documentation requirements.
• Communication Skills: Clear verbal communication and strong interpersonal skills in English and Kannada (Hindi is an added advantage).

Qualifications

• Experience Duration: Minimum 8 months to 1 year of hands-on experience in healthcare claims or TPA operations.