TPA -Reconciliation& Claim Settlement

Company Description

Dr. Shroff's Charity Eye Hospital (SCEH), established in 1926, has been a pioneer in providing compassionate, high-quality eye care and serves as one of North India's largest tertiary eye care institutions. With a network spanning Delhi, Uttar Pradesh, Rajasthan, and Uttarakhand, SCEH includes 7 Surgical Centres and over 100 Vision Centres. Upholding the principle that sight is a human right, 50% of surgeries are offered free or at highly subsidized rates to ensure accessible care for all. Over the past decade, SCEH has impacted the lives of over 14 million patients while also engaging in cutting-edge research, advanced technology adoption, and global eye care training initiatives under its SCEH 2.0 vision for the future.

Role Description

This is a full-time on-site role based in Delhi, India, for a TPA - Reconciliation & Claim Settlement professional. Key responsibilities include managing Third Party Administrator (TPA) reconciliation processes, ensuring accurate claim settlements, monitoring financial records, and resolving discrepancies. The individual will work collaboratively with internal departments and external stakeholders to improve efficiency, maintain compliance, and support the overall claim process.

Qualifications

· Perform reconciliation of credit billing transactions with Ayushman Bharat, TPAs, PSU panels, CGHS, ECHS, DGEHS, and corporate accounts.

· Verify bills, payment settlements, deductions, and outstanding amounts on a daily basis.

· Track pending payments and coordinate with internal departments for resolution of discrepancies.

· Prepare reconciliation MIS reports and share status updates with management.

· Handle portal reconciliation and ensure accuracy of claim submissions and settlements.

· Follow up with TPAs, AB and corporate clients regarding short payments, denials, and pending claims.

· Maintain records of invoices, credit notes, settlement details, and supporting documents.

· Identify billing variances and escalate unresolved issues in a timely manner.

· Support audit requirements by maintaining proper reconciliation documentation.

· Coordinate with operations and billing teams to ensure smooth workflow and closure of cases.

Required Skills

· Strong knowledge of AB, TPA, PSU billing and reconciliation process.

· Good understanding of hospital billing, settlements, and claim management.

· Proficiency in MS Excel (VLOOKUP, Pivot Tables, basic formulas).

· Ability to work on billing portals and ERP systems.

· Good analytical and communication skills.

· Attention to detail and accuracy in reconciliation.

Preferred Qualification

· Under Graduate/Graduate in Commerce preferred.

· Experience in healthcare or hospital billing industry preferred.

Key Competencies

· Multitasking ability

· Problem-solving approach

· Follow-up and coordination skills

· Time management

• · Accuracy and accountability

Can [Confidential Information] /7428898837