TPA Manager

Ohio Hospital & Medical Centre

0 years

3 - 4 Lacs

calcutta

Posted:3 days ago| Platform: GlassDoor logo

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Skills Required

audits training onboarding compliance reports resolve service

Work Mode

On-site

Job Type

Full Time

Job Description

TPA Management:

Oversee the day-to-day activities of contracted TPAs.
Ensure adherence to SLAs, KPIs, and regulatory requirements.
Evaluate and monitor TPA performance through audits and reports.
Coordinate training and knowledge-sharing sessions with TPAs.

Claims Oversight:

Supervise claims adjudication, settlement, and dispute resolution.
Ensure timely and accurate claims processing.
Review complex/high-value claims and provide decision support.

Vendor Coordination:

Manage TPA onboarding, renewal, and contract negotiations.
Establish strong relationships with TPA partners to ensure smooth collaboration.

Compliance & Reporting:

Ensure TPA operations comply with IRDAI (for India) or local regulatory guidelines.
Generate reports on claims trends, fraud detection, and TPA performance.
Assist in internal/external audits and implement corrective measures.

Customer Experience:

Address and resolve escalated complaints related to TPA services.
Work with customer service teams to improve end-user satisfaction.

Job Type: Full-time

Pay: ₹25,000.00 - ₹40,000.00 per month

Work Location: In person

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