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For Employers

TPA Manager

Silver Streak Multi Speciality Hospital

5 - 10 years

4 - 8 Lacs

gurugram

Posted:5 days ago| Platform:

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Skills Required

analytical skills excel tpa networking billing healthcare management reconciliation hospital administration management continuous improvement

Work Mode

Work from Office

Job Type

Full Time

Job Description

Silver Streak Multi-Speciality Hospital is seeking a detail-oriented and experienced TPA Manager to lead and streamline the hospital s Third-Party Administrator (TPA) operations. The ideal candidate should have minimum 5 years of experience in a TPA cell within a hospital setting and be we'll-versed in handling the complete cycle of patient approvals, claims processing, reconciliations, and recovery follow-ups. The role also involves coordination with insurance companies, empanelment of new TPAs, and ensuring timely collections and documentation.

Key Responsibilities:

Oversee the end-to-end TPA process, including patient pre-authorization, final approval, and billing coordination.
Liaise with various insurance companies and TPAs to ensure smooth communication and claim settlement.
Handle reconciliations and timely follow-ups for outstanding payments and shortfalls.
Monitor turnaround time for approvals , and ensure minimal delays in patient discharge processes.
Maintain accurate and updated documentation for all TPA-related interactions and audits.
Coordinate with clinical and non-clinical departments to ensure complete and compliant claim submissions.
Prepare and share regular MIS reports and dashboards related to TPA collections, rejections, and receivables.
Manage and onboard new TPAs, corporates, and insurance panels for expanding the hospital s network.
Address queries from patients and insurers with professionalism and clarity.

Skills Qualifications:

Graduate in any discipline; additional qualifications in Hospital Administration or Healthcare Management are preferred.
Minimum 5 years of relevant experience in the TPA department of a hospital.
Strong understanding of TPA protocols, insurance guidelines, and hospital billing systems .
Excellent communication and negotiation skills to handle insurance partners and patients.
Proficiency in MS Excel, hospital information systems (HIS), and TPA software.
Ability to manage time-sensitive processes under pressure with high attention to detail.
Knowledge of relevant statutory regulations, including IRDA guidelines.

Preferred Attributes:

Prior experience handling multiple TPAs and insurance providers.
Strong analytical skills with a proactive approach to recovery and reconciliation.
Ethical, process-driven, and focused on continuous improvement.
A team player who can also independently take ownership of key functions.

Why Join Us

Be part of one of the region s leading multi-speciality hospitals with a strong TPA and corporate network.
Opportunity to manage critical revenue functions and contribute to financial health.
Work in a system-driven environment with opportunities for professional growth.

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TPA Manager