TPA Manager

Role Overview

Bhamashah Swasthya Bima Yojana (BSBY)

Key Responsibilities

• Manage and coordinate with TPAs and insurance providers for cashless and reimbursement claims.
• Handle all processes under

  BSBY

  and

  PMJAY

  , ensuring compliance and efficient claim settlements.
• Ensure timely pre-authorization, approvals, and discharges for insured and scheme patients.
• Guide patients and families about insurance/TPA/BSBY/PMJAY eligibility, documentation, and claim processes.
• Maintain accurate records, MIS reports, and documentation for audits and scheme compliance.
• Coordinate with billing, admissions, accounts, and medical teams for seamless claim management.
• Monitor and review TPA and government scheme agreements, policies, and guidelines.
• Track claim trends, identify gaps, and recommend improvements to reduce denials.
• Build and maintain strong relationships with TPAs, insurance companies, and government scheme authorities.

Qualifications & Skills

• Bachelor’s degree in Healthcare Management, Business Administration, or a related field.
• 3–5 years of experience in hospital TPA/insurance management.
• Strong understanding of

  health insurance, BSBY, and PMJAY processes

  .
• Excellent communication, negotiation, and stakeholder management skills.
• Ability to lead a team and coordinate across hospital departments.
• Proficiency in hospital information systems and MS Office tools.

What We Offer

• Opportunity to work with one of Rajasthan’s top multi-specialty hospitals.
• A role with direct impact on patient satisfaction and healthcare accessibility.
• Growth-driven environment with career advancement opportunities.