TPA and insurance manager

The TPA & Insurance Manager will play a foundational role in setting up and operationalizing all processes related to private insurance, Third-Party Administrators (TPAs), and government health schemes such as Bhamashah Swasthya Bima Yojana (BSBY) and Ayushman Bharat PMJAY.
Initially, the focus will be on building systems, completing empanelments, documentation, and compliance groundwork so that cashless and scheme-based operations can start seamlessly when the hospital begins patient treatment (target 4–5 months).Once operational, the role will evolve into overseeing day-to-day TPA and scheme management.---Key Responsibilities — Pre-Operations PhasePrepare and submit empanelment applications for BSBY, PMJAY, and leading TPAs and insurance providers.Establish and document SOPs for cashless and reimbursement workflows, including pre-authorization, discharge, and billing reconciliation.Coordinate with hospital departments to map required infrastructure, staffing, and software documentation needed for empanelments.Create and maintain a master tracker of empanelment status, pending requirements, and expected go-live dates.Liaise with government officials, insurance companies, and TPA networks to ensure early onboarding.Set up claim documentation templates, billing formats, and MIS reporting systems in coordination with the IT and finance teams.Conduct training sessions for front-desk, billing, and clinical teams on scheme workflows and compliance norms.Maintain ongoing communication with scheme authorities to stay updated on any policy changes or new government notifications.---Key Responsibilities — Operational PhaseManage and coordinate all cashless and reimbursement claim operations with TPAs and insurers.Oversee pre-authorizations, discharges, and claim settlements for insured and government-scheme patients.Monitor claim submission timelines, rejections, and reconciliations, ensuring minimal pending amounts.Guide patients and families on eligibility, documentation, and scheme benefits.Prepare regular MIS and audit reports for management and compliance teams.---Qualifications & ExperienceGraduate/Postgraduate in Hospital Administration, Healthcare Management, Finance, or Commerce.5+ years of experience in hospital TPA/government-scheme coordination.Strong understanding of BSBY, PMJAY, and private TPA empanelment processes.Familiarity with claim-management software and hospital billing systems.Excellent communication, follow-up, and documentation skills.---Skills RequiredIn-depth knowledge of insurance workflows and empanelment documentation.Strong planning and coordination ability to build systems from scratch.Proficiency in Excel, Google Sheets, and online submission portals.Ethical, organized, and proactive work style.