TPA Manager

Key Responsibilities:

1. TPA & Insurance Coordination

Liaise with various TPAs, insurance companies, and corporate clients for emplacement and claim processing.

Ensure timely submission and follow-up of all pre-authorization and final claim documents.

Maintain records of all cashless and reimbursement patients.

2. Claims Management

Verify patient documents before submission to TPAs.

Monitor claim status, address rejections or short payments, and ensure timely resolution.

Coordinate with the billing department for correct coding and documentation.

3. Cashless & Reimbursement Process

Handle all cashless requests, approvals, and discharge intimations.

Educate patients and attendants about insurance procedures and entitlements.

Ensure smooth discharge process by coordinating with TPAs and consultants.

4. Documentation & Compliance

Maintain updated files and agreements of all TPAs and insurance companies.

Ensure compliance with NABH and other statutory requirements.

Prepare daily, weekly, and monthly reports on TPA operations and pending claims.

5. Team Management

Supervise TPA executives and ensure their performance and training.

Conduct periodic audits of TPA processes and claim files.

6. Financial Reconciliation

Coordinate with the accounts department for reconciliation of payments received from TPAs.

Track outstanding dues and initiate recovery measures when required.

Qualifications & Experience:

Graduate or Postgraduate in Hospital Administration / Finance / Commerce.

Minimum 5-7 years of experience in hospital TPA operations or insurance management.

Strong knowledge of insurance processes, claim documentation, and medical terminologies.

Key Skills:

* Excellent communication and coordination skills.

* Strong analytical and problem-solving ability.

* Proficiency in MS Office and hospital billing software.

* Ability to manage a team and handle pressure situations.

Job Types: Full-time, Permanent

Pay: ₹45,000.00 - ₹80,000.00 per month

Work Location: In person