TPA and Insurance Tie-up Coordinator

Job Title: TPA & Insurance Tie-ups Coordinator
Department: Business Development
No. of Positions: 1
Position Type: Full-Time (Work from Office)
Location: Whitefield, Bengaluru

About RxDx

RxDx Clinics is a Bengaluru-based NABH-NABL accredited multispeciality healthcare chain. Founded in 2007, RxDx is guided by the core principles of delivering the best health outcomes, at optimal cost, with utmost patient satisfaction.

Two main hubs of RxDx are located at Whitefield and Malleswaram, with peripheral branches in Kadugodi and Siddapura. In 2023, RxDx expanded with new centres at Dommasandra Circle and Diamond District, Domlur. In 2024, the organisation strengthened its presence in North Bengaluru with its flagship clinic in Jakkur and its first apartment clinic at RxDx Alpine Eco.

In 2025, four new centres were inaugurated at RR Nagar, Adarsh Palm Retreat (Bellandur), Electronic City, and Budigere Cross. Including its corporate health partnerships, RxDx now operates approximately 30 medical centres across Bengaluru.

Job Summary

RxDx is looking for a TPA & Insurance Tie-ups Coordinator to manage the end-to-end cashless insurance process, including empanelment with insurance companies and TPAs, pre-authorizations, claim management, and final settlements.

The role requires strong knowledge of health insurance workflows, IRDAI guidelines, and coordination with TPAs, insurance auditors, doctors, and internal billing teams to ensure smooth approvals and minimal claim deductions. The candidate will also support patients and families during admissions and discharges, ensuring transparency and timely processing of insurance claims.

Key Responsibilities

Strategic Insurance Tie-ups & Relationship Management

• Initiate and manage empanelment (tie-ups) with new Insurance Companies and Third-Party Administrators (TPAs).

• Coordinate with management during negotiation of package rates and MOU terms for procedures and surgeries.

• Maintain strong working relationships with TPA managers to expedite approvals and resolve disputed claims.

• Ensure timely renewal of existing insurance and TPA agreements and MOUs.

Cashless Desk & Pre-Authorization Management

• Counsel patients and attendants regarding insurance coverage, exclusions, eligibility, and the cashless process at the time of admission.

• Collect required clinical and administrative documents and initiate pre-authorization requests through TPA portals or email within stipulated timelines (typically 26 hours of admission).

• Coordinate with treating consultants to promptly respond to medical queries raised by TPA doctors.

• Raise enhancement requests with appropriate clinical justification if treatment costs exceed initial approvals.

Claims Processing & Discharge Coordination

• Compile final bills, discharge summaries, and investigation reports to obtain final authorization from TPAs at the time of discharge.

• Identify and resolve discrepancies between hospital bills and approved amounts to minimize deductions.

• Support reimbursement cases by preparing and providing complete, signed, and stamped documentation to patients.

Compliance, Documentation & Reporting

• Ensure adherence to IRDAI guidelines, GIPSA norms, and insurer-specific workflows.

• Maintain accurate records of approvals, claims, denials, and settlements.

• Track and monitor key KPIs such as pre-authorization turnaround time, claim settlement ratio, and denial rates.

Qualifications & Experience

• Education: Graduate in any stream (B.Com / BBA / B.Sc preferred). Diploma in Health Insurance or Hospital Administration is an added advantage

• Experience: 25 years of hands-on experience at a Hospital Insurance / TPA Desk.

• Proven track record of maintaining a low claim rejection or denial ratio.

Key Competencies & Skills

Insurance & Domain Knowledge

• Strong understanding of IRDAI regulations, GIPSA portals, and insurance workflows.

• Familiarity with major TPAs and insurers (Medi Assist, Raksha, Star Health, etc.).

• Ability to understand medical terminology, ICD-10 diagnoses, and procedure codes for claim justification.

Technical & Operational Skills

• Proficiency in Hospital Information Systems (HIS) and insurance/TPA portals.

• Strong documentation, tracking, and follow-up capabilities.

Communication & Stakeholder Management

• Excellent verbal and written communication skills in English and local language