| Detail | For this role |
|---|---|
| Department | Hospital Administration |
| Level | Entry level |
| Reports to | TPA Manager |
| Direct reports | None |
| Experience | Fresher or up to 3 years at a hospital insurance or TPA desk |
TPA Executive job description template
Copy this job description, replace the text in square brackets and post it on your careers page or a job portal.
Job title: TPA Executive
Department: Hospital Administration
Reports to: TPA Manager
Location: [City], [office, branch or site]
About the role
A TPA Executive processes insurance and cashless cases at a hospital's TPA desk. They raise pre-authorisation requests, upload documents to insurer and TPA portals, follow up approvals, and prepare claims after discharge. The role coordinates with treating doctors for notes and summaries, and with billing for correct deductions. In an Indian hospital the TPA executive keeps cashless cases moving so patients are not stuck at admission or discharge, tracks pending approvals, and works under the TPA manager to keep query and rejection rates low.
Key responsibilities
- Raise cashless pre-authorisation requests with correct patient, policy and treatment details at admission.
- Upload documents to insurer, TPA and government scheme portals and track each request to approval.
- Follow up pending approvals and enhancement requests so admissions and discharges are not delayed.
- Coordinate with treating doctors for justification notes, discharge summaries and extra documents.
- Prepare and submit claims after discharge with complete documents to avoid queries.
- Coordinate with billing so cashless deductions and co-payment are applied correctly.
- Explain cashless limits, co-payment and non-covered items to patients at admission and discharge.
- Answer insurer and TPA queries within the window to keep claims from closing.
- Maintain the tracker of pending pre-authorisations, claims and short-paid cases.
- Escalate stuck approvals and large deductions to the TPA manager.
Requirements
- Graduate in commerce, science or any stream
- Knowledge of health insurance and cashless processes
- Basic medical terminology is an advantage
- Fresher or up to 3 years at a hospital insurance or TPA desk
KRAs and KPIs for a TPA Executive
Key result areas for the appraisal form, each with a KPI you can measure every month or quarter.
| Key result area | How to measure it |
|---|---|
| Approval speed | Pre-authorisation obtained within the target time for most cases |
| Query rate | Payer queries on submitted requests kept below the agreed limit |
| Claim readiness | Claims submitted with complete documents within the payer window |
| Follow-up | Pending approvals and claims followed up daily, none left unattended |
| Deduction support | Documentation helps keep deductions within the desk target |
| Patient handling | Cashless queries explained clearly, escalations kept low |
Skills and tools
Tools used day to day: Insurance and TPA portals, Government scheme portals, Hospital Information System (HIS), MS Excel, Claim tracking sheet.
Reporting line and career path
Next roles: Senior TPA Executive, TPA Manager, Insurance Desk Coordinator
Interview questions for a TPA Executive
- Walk me through raising a cashless pre-authorisation for a planned surgery.
- An approval is delayed and the patient wants to be discharged. What do you do?
- What documents do you check before submitting a claim to avoid a query?
- A surgery ran longer than planned. How do you handle the enhancement?
- How do you keep track of many pending approvals at once?
- How do you explain a co-payment to a patient who expected fully cashless treatment?
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What does a TPA executive do in a hospital?
A TPA executive processes insurance and cashless cases at the hospital's TPA desk. They raise pre-authorisation requests, upload documents to insurer and TPA portals, follow up approvals, and prepare claims after discharge. They coordinate with doctors for notes and with billing for correct deductions, and keep cashless cases moving so patients are not stuck at admission or discharge.
What qualifications do you need to become a TPA executive?
A graduate degree in commerce, science or any stream is the usual base, with knowledge of health insurance and cashless processes. Basic medical terminology is an advantage for reading notes and summaries. The role suits freshers and early-career candidates who are accurate, organised and comfortable following up with insurers and doctors.
What is the difference between a TPA executive and a TPA manager?
A TPA executive processes cases at the desk: pre-authorisation, document upload, follow-up and claim preparation. A TPA manager leads the desk, owns approval speed, deduction control and payer reconciliation, manages empanelments, and handles escalations. The executive does the hands-on work, while the manager sets process, handles insurers and reports to finance.